目的 观察小分子生物活性肽肾上腺髓质素2(ADM2)在"两肾一夹"肾性高血压大鼠中肾脏的表达,探讨其在该病理生理过程中的作用.方法 清洁级雄性SD大18只,体重180～220 g,随机分为对照组和模型组.模型组行两肾一夹手术,对照组行假手术.8周后左心导管插管法测定收缩压(SBP),舒张压(DBP),平均颈动脉压(mCAP)、左心室舒张末压(LVEDP)以及左心室内压最大上升/下降速率,同时测定LVM/BW;采用逆转录-聚合酶链反应方法测定肾脏组织IMD/ADM2的mRNA含量变化;采用免疫组织化学方法(IHC)测定左心室肾脏组织IMD/ADM2的表达部位,并对其表达强度进行半定量分析.结果 模型组颈动脉SBP、DBP、mCAP、LVEDP和左心室内压最大上升/下降速率比对照组升高(P<0.01),左室肥厚指数比对照组升高(P<0.05);模型组肾脏组织IMD的mRNA表达比对照组高(P<0.01);模型组肾脏组织IMD免疫组化的累积光密度比对照组高(P<0.01),且主要分布在肾小动脉血管平滑肌细胞及肾小管细胞的细胞核.结论 IMD/ADM2在肾性高血压大鼠的肾脏内基因表达上调及蛋白合成增加,提示IMD/ADM2在肾性高血压致肾脏病变的过程中具有重要的调控意义.

Objective To analyze the correlation between the change in carotid intima / media membrane (I/M) ratio and renal atherosclerosis in experimental rabbit carotid atherosclerosis models.Methods Forty-eight rabbits were randomly divided into the blank group,the control group and the model group by the random number table method,with 16 rabbits in each group.The blank group was not given any intervention,which was given basal feed.The control group was given high-fat diet of 120 g/d.The model group was given 7 d of high-fat diet and then the rabbits were changed into bilateral carotid atherosclerosis models through carotid intima air drying after 12 h of fasting (without fasting water).The bilateral operative carotid arteries and renal artery specimens of all rabbits were obtained to analyze the I/M ratio after routine paraffin embedding,sectioning and HE staining.Serum levels of triglyceride (TG),total cholesterol (TC) and C-reactive protein (CRP) were determined at the end of the experiment.Urinary microalbumin /urine creatinine (UACR) was analyzed and correlation analysis was performed.Results HE staining under light microscope was normal in the carotid artery and renal artery of rabbits in the blank group.In the control group,there was slight intimal hyperplasia in the carotid artery and slight hyperplasia and stenosis in the renal artery,without obvious lipid deposition.In the model group,there was obviously proliferated and thickened carotid intima,a large number of foam cells accumulated in the intima,extensively proliferated intima of the renal artery and seriously narrowed vessels,and thickened intima was accumulated foam cells at high magnification.Compared with the blank group,the carotid artery,renal artery I/M ratio in the control group and model group were significantly increased,serum TG,TC,CRP and UACR were significantly increased,and he carotid artery,renal artery I/M ratio and serum TG,TC,CRP and UACR in the model group were significantly highter than those of control group,the differences were statistically significant (P ＜ 0.05).The I/M ratio of carotid artery in rabbit carotid atherosclerosis models was positively correlated with the I/M ratio of renal artery,CRP and UACR (P ＜0.05),but there was no significant correlation with TG or TC (P ＞ 0.05).Conclusion Carotid atherosclerosis can promote the occurrence of renal atherosclerosis,which may be related to inflammatory reactions,vascular endothelial cell injury and renal vascular diseases.

Objective To investigate the cardiac protective effect of levosimendan in patients with tako-tsubo cardiomyopathy (TTC).Methods A total of 31 TTC patients collected from Department of Intensive Care Unit,the 2ndAffiliated Hospital of Wenzhou Medical University from January 2006 to December 2016 were retrospectively studied,who were divided to the treatment group (n=12) and the control group (n=19) according to the use of levosimendan.Patients in the treatment group were used levosimendan strictly according to the instructions with the initial loading dose of 6 ~ 12 μg/kg through intravenous infusion for more than 10 min,followed by continuous minipump infusion of 0.1 μg·kg-1·min-1.The control group did not use levosimendan.The general data and related cardiac indexes which included the left ventricular ejection fraction (LVEF),the left ventricular end diastolic dimension (LVDD),the cardiac troponin I (cTnI) and the pro-brain natriuretic peptide of TTC patients in the two groups were compared.At the same time,patients were followed up for an average of 22.3 months to record their long-term survival.Results The acute physiology and chronic health evaluation (APACHE)Ⅱ scores [(18 ± 4) vs.(16 ± 4),t=2.057,P=0.049] and the ICU length of stay [(16 ± 5)d vs.(21 ± 6) d,t=2.110,P=0.044] of patients in the two groups were significantly different.The LVEF of patients in the treatment group was higher as compared to the control group [(59+9) % vs.(52+8) %,t=2.062,P=0.048].The peak values of cTnI [(8.7 ± 3.2)μg/L vs.(11.4 ± 3.6)μg/L,t=2.120,P=0.043] and pro-brain natriuretic peptide [(3 656 ± 1 043)ng/L vs.(4 753 ± 965)ng/L,t=2.989,P=0.006] in the treatment group were lower than those in the control group.There was no significant difference in the overall survival of the two groups with 3 cases of death in the treatment group and 6 cases of death in the control group (P = 0.325).Conclusion Levosimendan has the potential to promote the recovery of cardiac functions,reduce the injury of cardiac myocytes and shorten the ICU length of stay in TTC patients,but it has no effect on their overall survival.

临床见习教学是临床教学计划的重要组成部分，是医学生从纯课堂理论教育走向临床实践教育的过渡阶段，也是医学生角色转换的启蒙阶段，如何把好此阶段的教育对医学教育的质量以及对医学生今后的发展有着至关重要的影响。在新的医学教育形势下，探求出一种更符合我国医学教育现状、更能提高临床见习教学效果的模式是非常有必要的。内科教研室就此目的采用随机双盲的原则对两种见习教学模式进行了探索与实践，认为此两种见习教学模式均是可行的，均有各自的优点。

Objective To investigate the value of plasma d- dimer, troponin I and their ratio in etiological diagnosis of acute chest pain. Methods The data of 786 patients (534 male, 252 female, aged from 28 to 93 years) admission for acute chest pain and diagnosed as either acute myocardial infarction (AMI), acute pulmonary embolism (APE) or acute aorta dissection (AAD) were analyzed retrospectively. AMI was divided into ST segment elevation and non- ST segment elevation myocardial infarciton (STEMI, NSTEMI). Serum d- dimer, troponin I and their ratio were analyzed. The receiver operating characteristic curve (ROC curve) was performed to determine the value of d- dimer, troponin I, the ratio of d- dimer to troponin I (Rd) and troponin I to d- dimer (Rc) in the differential diagnosis of STEMI, NSTEMI, APE and AAD. Results D- dimer was significantly higher in AAD(11.13μg/ml) and APE groups(3.92μg/ml)than STEMI(0.38μg/ml) and NSTEMI groups(0.34μg/ml)(al P<0.05). There was significant difference between ADD and APE groups(P<0.05) and no significant difference between STEMI and NSTEMI groups. Troponin I was significantly higher in STEMI group(5.000ng/ml) than in NSTEMI group (3.035 ng/ml)(P<0.05). Both of them were significantly higher than 0.030 ng/ml in APE and AAD groups (al P<0.05). From STEMI to NSTEMI to APE to AAD, Rc was decreasing and Rd was increasing. There was significant difference between any two groups (al P<0.05). The ROC curve showed that Rc was superior to troponin I and Rd superior to d- dimer in the differential diagnosis of these diseases. Conclusion The ratios of D- dimmer to troponin I and troponin I to D- dimmer are benefit to improve the sensitivity and specificity of each parameter in the diagnosis of acute chest pain.

Objective To investigate the effect of microRNA- 34a (miR- 34a) on serum- free- induced apoptosis in car-diomyocytes and its mechanism. Methods Rat cardiomyocytes H9C2 were cultured in vitro and divided into three groups: in experimental group H9C2 cel s were transfected with miR- 34a inhibitor, blank control group had no transfection, in negative con-trol group cel s were transfected with randomly synthesised miRNA. H9C2 cel s were cultured in serum- free medium to induce apoptosis after transfection. Western blot was preformed to examine the expression of Caspase- 3 and Bcl- 2 protein. Results Western blot showed that compared with blank control and negative control groups, the expression of Caspase- 3 was signifi-cantly decreased in experimental group (P<0.05), while the expression of Bcl- 2 was significantly increased in the experimental group(P<0.05). Conclusion Transfection of miR- 34a inhibitor down- regulates miR- 34a expression, and inhibites serum- free-induced apoptosis in H9C2 cel s, which is associated with the up- regulation of Bcl- 2.

局灶性房性心动过速是相对少见的室上性心律失常之一,射频导管消融（下称消融）是根治房性心动过速的有效方法,但成功率低于房室折返性和房室结折返性心动过速。近年来随着三维标测系统的应用,房性心动过速起源部位能够被精确、快速定位,不仅大大提高了房性心动过速消融的成功率,也缩短了导管消融时间并减少了射线量。近期

目的 通过检测血清巨噬细胞移动抑制因子(MIF),探讨冠心病患者不同类型心绞痛及冠脉病变程度与MIF的相关性.方法 根据冠脉造影结果,将115例住院患者分为对照组53例和冠心病组62例.冠心病组按Braunwald分类方法,根据临床表现分为稳定型心绞痛组(SAP) 10例和不稳定型心绞痛组(UAP) 52例,根据Gensini积分法对冠心病患者冠状动脉狭窄程度进行定量评估,采用酶联免疫吸附试验(ELISA)检测两组血清MIF浓度.结果 冠心病组(65.94μg/L) MIF水平明显高于对照组(48.08 μg/L).在冠心病组中,UAP组血清MIF浓度明显高于SAP组,同时SAP组和UAP组血清MIF浓度均高于对照组(65.94μg/L vs 48.08μg/L,P＜0.05).不同冠脉病变程度之间血清MIF浓度无统计学差异.结论 血清MIF浓度的增高可能与冠心病的发生发展相关,同时MIF水平的高低可以反映冠脉粥样斑块的稳定性,为冠心病的诊断及干预治疗提供依据,但冠脉狭窄程度与血清MIF浓度无明显相关性,不能用于预测冠脉病变情况.

Objective:To explore the correlation between pulse pressure and renal arterial resistance by comparing renal arterial resistive index(RI) of hypertension patients with different pulse pressure. Methods:The selected patients were divided into two groups:the high pulse pressure group(19 cases) and the low group(36cases) based on the 24-hour ambulate blood pressure monitoring profiles. Blood glucose,plasma lipids and creatinine were determined. Color Doppler ultrasound was applied to determine the renal blood flow including peak velocity in systole(Vs),end-diastolic velocity(Vd) of main renal artery(MRA),segmental renal artery(SRA) and interlobar renal artery(IRA). Renal arterial resistence index was calculated. Results:Patients in the high pulse pressure group had higher RI than whom in the low group. The difference was statistically significant(P<0.01). There were positive correlation between the renal arterial RI and the pulse pressure(P<0.05). Conclusion:Renal arterial RI has intimate related to pulse pressure. Hypertension with high pulse pressure will increase renal arterialresistance.

Intradialytic hypotension (IDH) is a global public health problem. A rising number of IDH sufferers resort to Chinese patent medicine, Shengmai Injection (SMI) in China. The objectives of present study are to assess the effectiveness and safety of SMI as an adjunct therapy for IDH. A systematic search of 6 medical databases was performed up to December 2011. Randomized trials involving SMI adjuvant therapy versus conventional therapy were identified. RevMan 5.0 was used for data analysis. Ten randomized clinical trials with 437 participants were identified. Methodological quality was considered inadequate in all trials. Compared with conventional therapy, SMI adjunct therapy showed significant effects in improving the clinic effective rate (P < 0.01), decreasing the incidence of IDH episode (P < 0.01), decreasing the frequency of nursing interventions (P < 0.01), and increasing diastolic blood pressure (P < 0.01). There was no statistical significance in the improvement of mean arterial pressure (P = 0.22) and systolic blood pressure (P = 0.08) between two groups. Four studies had mentioned adverse events, but no serious adverse effects were reported in any of the included trials. In conclusion, SMI adjunct therapy appears to be potentially effective in treatment of IDH and is generally safe. However, further rigorous designed trials are needed.

Aim To study the changes and probable role of intermedin/adrenomedullin 2(IMD/ADM2),a novel micromolecular bioactive peptide,in rats with Two-kidney,One-clip renal hypertension. Methods Eighteen healthy male Sprague-Dawley(SD)rats(180~220g)were randomly divided into normal control group and model group. The rats of model group were cliped with one renal artery,and the contral group only separation one renal artery. After 8 weeks,the left carotid artery was cannulated with a catheter and connected to apressure transducer to monitor the SBP,DBP,mCAP,LVEDP and LV±dp/dtmax. Meanwhile,the LVM/BW was also measured. IMD/ADM2 mRNA expressed in the left ventricular heart muscles were studied with reverse transcription-polymerase chain reaction(RT-PCR). The location and distribution were detected in the left ventricular heart muscles by using immunohistochemical(IHC),and semiquantitative analysis was performed in positive regions by using special software-Image Pro Plus(IPP). Results The systolic blood pressure,mean carotid artery pressure,maximum left ventricular developed pressure increase or decreased rate(±dp/dtmax)and LVEDP of 2K1C group were higher than those of normal control group significantly(all P<0.01);The LVM/BW of 2K1C group were higher than those of normal control group(P<0.05);The expression of IMD/ADM2 mRNA of the model group were increased(P<0.01)comparing to control group in the left ventricular organization respectively. The cumulative light density of IMD/ADM2 in the left ventricular organization showed that the model group was higher(P<0.01)than control group,and the main expression of IMD/ADM2 in myocardial issues were cell nuclei,inflammatory cells. Conclusion These results confirm IMD/ADM2 played an important role in the process of renal hypertension by the mRNA expression and the cumulative light density of IMD/ADM2 are increased In the left ventricular heart muscles of the renal Hypertension rats.

OBJECTIVE To observe the protective effects of astragaloside on inflammatory injury induced by oxidative low density lipoprotein(ox-LDL) in endothelial progenitor cells(EPCs),and find the potential mechanisms.METHODS Total mononuclear cells(MNCs) were isolated from peripheral blood of healthy young human volunteers by ficoll density gradient centrifugation,and plated on fibronectin-coated culture dishes.After incubation for 7 days,attached cells will be collected and randomized into five groups: control group,ox-LDL-intervented group,and three astragaloside-intervented groups which were respectively added with different concentrations of astragaloside(2,10 and 50 μg·mL 1) and 100 μg·mL 1ox-LDL.After intervention for 24 hours,the capacities for EPCs vasculogenesis,migration,adherence,as well as proliferation separatively were evaluated and the levels of IL-6 and TNF-α in the culture supernate of the five groups were measured.RESULTS Compared with the control group,the capacities for EPCs vasculogenesis,migration,adherence,as well as proliferation were impaired and the levels of IL-6 and TNF-α were obviously elevated in the ox-LDL-intervented group(P<0.01).In contrast,these capacities as well as IL-6 and TNF-α levels were improved in astragaloside-intervented groups.CONCLUSION Astragaloside can protect the EPCs capacities of vasculogenesis,migration,adherence,and proliferation which would be injured by ox-LDL.The potential mechanism might be related to its anti-inflammatory features.

Objective To explore ECG characteristics of idiopathic premature ventricular contractions (PVCs)and the efficacy and safety of radiofrequency catheter ablation (RFCA). Methods 351 patients with symptomatic PVCs under-went RFCA. Ablation was performed by a catheter with temperature control guided by pace mapping and activation se-quence mapping. The end point of the procedure was that PVCs disappeared and could not been induced by intravenous isoproterenol. 24- hour Holter monitor was performed at 1 month, 6 month, 1 year and 2 year, respectively, after operation. Results 291 cases(67.8%female)had PVCs from right ventricle and 60 cases from left ventricle(60.0%male). The ma-jority of PVCs originated from right ventricular outflow tract, the rest from tricuspid annulus, aortic sinus and left ventricular septum. The success rate of ablation of PVCs from left and right ventricle were 80.0% and 93.5%,respectively. 13 cases had PVCs recurred in 2 years and 31 cases were lost to fol ow- up. Conclusion RFCA of PVCs is safe and effective. The ECG features and ablation success rate vary with origins of PVCs.

Smoking is a major risk factor for atherosclerosis. In this study, we evaluated the effects of benzo[a]pyrene (BaP, a prominent component of tobacco smoke) on the function and pro-inflammatory response of human endothelial progenitor cells (EPCs). EPCs were isolated from umbilical cord blood and treated with different concentrations (10,20 and 50 mu mol/l) of BaP. The proliferation, migration, adhesion and angiogenesis of BaP-treated EPCs were evaluated using the cell counting kit-8 (CCK-8), Transwell assay, adhesion assay and in vitro tube formation assay, respectively. The activation of nuclear factor-kappa B (NF-kappa B) was evaluated by measuring the mRNA expression of NF-kappa B p65 and p.50 by real-time RT-PCR and NF-kappa B translocation assay. Reactive oxygen species (ROS) production was determined by the reduction of fluorescent 2',7'-dichlorofluorescein diacetate (DCFH-DA). The results demonstrated that BaP treatment significantly inhibited the proliferation, migration, adhesion and angiogenesis of EPCs in vitro. In addition, BaP induced the release of interleukin (IL)-1 beta and tumor necrosis factor-a from these cells. Moreover, the exposure of EPCs to BaP induced ROS generation and the activation of NF-kappa B. Experiments with EPCs pre-treated with pyrrolidine dithiocarbamate, an inhibitor of NF-kappa B, revealed that the BaP-mediated inhibition of proliferation, migration, adhesion and angiogenesis of EPCs is mainly regulated by NF-kappa B. Thus, tobacco smoke may induce oxidant-mediated stress responses in EPCs and impair their function via the activation of the NF-kappa B pathway.

目的 了解自发性冠状动脉夹层病变(SCAD)及其介入治疗.方法 回顾性研究10例SCAD患者,介入治疗9例,了解治疗并发症以及预后.结果 8例患者在冠状动脉夹层处直接植入支架;1例患者导引导丝始终未能进入血管真腔,放弃介入治疗,改为开胸冠状动脉搭桥治疗.1例未予介入干预,仅药物治疗.行冠状动脉支架介入治疗患者随访3个月～2年,未发生心绞痛或心肌梗死等心脏事件.所有患者均存活.结论 介入治疗可以作为冠状动脉自发夹层病变治疗的有效方法 之一,但SCAD患者的治疗是选择内科药物保守治疗、冠状动脉介入治疗还是冠状动脉搭桥术,应根据冠状动脉造影时夹层的范围、形态、夹层阻塞血管的程度及对血流的影响等因素而决定.

OBJECTIVE To study the intervention role of atorvastatin in restenosis after angioplasty of iliac artery in rabbits,investigate its relationship with metalloproteinases(MMPs) and protein kinase C(PKC).METHODS All 40 white ♂ rabbits of Japan were randomly divided into 5 groups(n=8):model group;atorvastatin group with different doses of high(2 mg·d 1),medium(1 mg·d 1) and low(0.5 mg·d 1)(iliac artery secondary injury);sham operation group(femoral artery ligation).HE dyeing was carried out in the target blood vessel after one month.Image pathology was used to analyse the intima area,tunica media area,vascular lumen area,index of intima hyperplasia and luminal stenosis.Immunohistochemical method was used to detect the expression of MMP-2,MMP-9 and PKC.RESULTS Iliac artery secondary injury could successfully bulid a restenosis model after angioplasty.Compared with model group,as the dosage increased,the atorvastatin groups had smaller intima area,tunica media area,index of intima hyperplasia and luminal stenosis,and there was a significant increase in the vascular lumen area(P<0.01),meanwhile,the expression of MMP-2,MMP-9 and PKC significantly reduced(P<0.01).CONCLUSION Atorvastatin can significantly reduce restenosis after rabbit angioplasty,the probable mechanism is through the way of PKC to inhibit the expression of MMPs in target blood vessels.

Objective To explore the relationship of exercise blood pressure variability with urinary albumin excretion and arterial stiffness in patients with essential hypertension.Methods Fifty normal persons 64.5±5.1 years old were evenly divided by gender as control group.The study group 65.3±5.7 years old consisted of eighty patients with essential hypertension.Exercise blood pressure was measured by treadmill exercise.24-hour urine protein was detected with Coomassie brilliant blue method,and arterial stiffness was evaluated on the basis of brachial-ankle pulse wave velocity.Results Patients with essential hypertension exhibited greater urine protein and higher pulse wave velocity and exercise blood pressure variability campared with those with normal pressure.In hypertensive group,excercise blood pressure variability was related to baPWV(r=0.576,P<0.01)and 24h-UPRO(r=0.510,P<0.01).In control group,excercise blood pressure variability was related to baPWV(r=0.423,P<0.01)and 24h-UPRO(r=0.376,P<0.05).The correlativity of exercise blood pressure variability with baPWV and 24h-UPRO in the hypertensive group was greater than in the control group.Conclusion The increasing variability of exercise blood pressure is an important clinic character in hypertensions,which could induce the decrease of renal function and arterial stiffness at the early stage.

Objective: To explore the relationship between left ventricular ejection fraction(LVEF) and heart size.Methods: The clinical datas of 641 patients with dilated cardiomyopathy,hypertensive heart disease,coronary heart disease,or degenerative heart disease who were admitted to the Second Affiliated Hospital of Wenzhou Medical College from 2009 to 2011 were retrospectively analysed.These patients were divided into two groups by LVEF(normal LVEF:≥50% and degraded LVEF:<50%).Various physiological indexes such as LVEF,left ven-tricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left atrial diameter(LAD) and right ventricular diameter(RVD) were tested with Doppler echocardiography.Results: The values of LVEDV,LVESV,LAD and RVD of degraded LVEF group were higher than those of the group with normal LVEF,and the differences had statistical significance(P <0.01).There were all significantly negative correlations between LVEF and LVEDV,LVESV(r=-0.726,P <0.01;r=-0.828,P <0.01).Conclusion: There are significantly negative correlations between LVEF and LVEDV and LVESV,and with the enlargement of LVEDV and LVESV,the numerical value of LVEF continues to decrease.

目的 探讨血尿酸水平与冠状动脉病变严重程度的关系.方法 入选338例经冠状动脉造影检查确诊为冠心病的患者,根据冠状动脉造影结果分为单支病变组100例,双支病变组78例,多支病变组160例.测定3组空腹血尿酸、血脂、血糖等各项指标并进行比较,最后分析血尿酸与冠状动脉病变严重程度的关系.结果 单支病变组、双支病变组、多支病变组血尿酸水平分别为(299.66±50.23)、(368.97±74.49)、(415.01±82.27)μmol/L,3组差异具有统计学意义(P＜0.01);性别、高血压、血尿酸水平、TC、LDL-C与冠心病病变严重程度具有显著相关性(P＜0.01),年龄、吸烟、空腹血糖与冠心病病变程度具有相关性(P＜0.05),而TG、HDL-C与冠心病病变严重程度无相关性(P ＞0.05).进一步采用偏相关分析,剔除性别、年龄、吸烟、高血压、空腹血糖、TC、LDL-C对冠心病病变严重程度的影响后,血尿酸水平与冠心病病变严重程度仍具有显著相关性(P＜0.01);最后进行线性回归分析,得回归方程y=0.104+0.006x.结论 血尿酸水平与冠状动脉病变的严重程度密切相关,检测血尿酸水平有可能成为一项有价值的、能预测冠心病事件的常规检查方法.

Objective To investigate whether carotid atherosclerosis aggravates aorta atherosclerosis in rabbit model.Methods A total of 16 male Japanese white rabbits were randomly divided into sham operation(control) and air-drying operation(experiment) groups.The baroreceptor reflex sensitivity(BRS) of heart rate was measured for rabbits after 8 weeks cholesterol feeding.All animals were executed for pathological examinations and measuring the intima-media thickness(I/M ratio).Results Carotid and aorta I/M ratios were significantly higher in the rabbits of operation group(1.28±0.082 and 0.65±0.218,respectively) than in the rabbits of control group(0.04±0.015 and 0.41±0.175,respectively)(P<0.05).The BRS of heart rate was significantly lower in the rabbits of operation group(1.02±0.098) than in the rabbits of control group(1.23±0.121)(P<0.05).Conclusion Carotid atherosclerosis may aggravate the aorta atherosclerosis through the decline of BRS.