Abstract:Atrial fibrillation（AF） is one of the most common clinical tachyarrhythmia，which is seen most frequently in the elderly. Ag－ing is regarded as an important risk factor for AF. A lot of researchers find that atrial remodeling plays an important role in occurrence and maintenance of the age-related AF. The changes of ion channel currents and its channel protein or gene expression in atrial my－ocytes are related to occurrence of atrial remodeling. This paper made a review on the recent studies of the relationship between AF and the changes which leaded by aging in atrial remodeling and ion channels.

Abstract:Atrial fibrillation（AF），known as a common supraventricular arrhythmia with substantial morbidity，has become an increas－ingly serious problem all over the world. The surgical approach to treat atrial fibrillation has had great advances in the past few years. New technologies have allowed the creation of transmural lesions on a beating heart through alternative，less-invasive incisions. It should be routinely proposed in most patients with permanent or paroxysmal AF undergoing cardiac surgery. Surgical ablation for lone atrial fibrillation can now be successful performed utilizing minimally invasive techniques. Further studies are warranted to determine whether the hybrid approach and total robotic cardiac surgery are efficient，especially in patients with long-standing persistent and persistent lone AF.

Abstract:In recent years，morning blood pressure surge（MBPS） has been taken as an indicator of hypertension. At home and abroad，a number of studies have confirmed that the MBPS is one of the risk factors of cardiovascular events such as stroke，myocardial in－farction，angina pectoris，malignant arrhythmia，which independent of average systolic and diastolic pressure. MBPS can accelerate the heart，brain，kidney，arteries and other target organ damage，and can also increase the incidence of cardiovascular events. By searching the database of CNKI，VIP，Wan Fang，PubMed etc，the author included the clinical trials of MBPS from 2003 to 2013 and discussed on the definition and classification of MBPS and the relationship between MBPS and target organ damage.

Abstract:Objective：To determine the effect of losartan on chronic cigarette smoke-induced PAH and its possible mechanism. Methods：Rats were randomly divided into four groups according to the factorial design：A group：control；B group：control plus losar－tan；C group：smoke exposure only；D group：smoke exposure plus losartan. The rats in C and D groups were daily exposed to cigarette smoke for 6 months in the absence and in the presence of losartan. After 6 months，right ventriculus systolic pressure（RVSP） was ex－amined. Tissue angiotensin Ⅱ（AngⅡ） levels were measured by iodine-125 radioimmunoassay（RIA） and angiotension converting enzyme 2（ACE2） in lung homogenates were measured by Western blot. Results：Elevated RVSP，thickened wall of pulmonary arteries with apparent medial hypertrophy along with increased AngⅡ and decreased ACE2 levels were observed in smoke-exposed-only rats. Losartan administration ameliorated pulmonary vascular remodeling，inhibited the smoke-induced RVSP and AngⅡ elevation and partially reversed the ACE2 decrease in rat lungs. Conclusion：The results suggest that losartan may be therapeutically useful in the chronic smoking-induced pulmonary vascular remodeling and PAH and ACE2 may be involved as part of its mechanism. Our study might provide insight into the development of new therapeutic interventions for PAH smokers.

Abstract:Objective：To investigate the effect of curcumin on expression of phosphoinositide-3-kinases-γ（PI3K-γ） in sepsis induced myocardial dysfunction（SIMD） mice． Methods：The 60 male c57bl/6 mice were randomly divided into control（Con），sepsis（Sep），curcumin（Cur） and DMSO groups（n=15 per group） by completely randomized digital table study. Mouse SIMD model was in－duced by intraperitoneal injection of 10 mg/kg lipopolysaccharide（LPS）. Mice in Cur group were injected with 200 mg/kg curcumin at 30 min after LPS administration；those in Con and Sep groups with an equal volume of sterile saline solution and those in DMSO group with an equal volume of DMSO． The left ventricular systolic pressure（LVSP），left ventricular end-diastolic pressure（LVEDP） as well as mximum rate of left ventricular pressure development and decay（LV±dp/dt-max） in various groups were monitored by BL-410 multiple monitor in the right carotid artery. Histopathological changes of cardiac muscles were observed by HE staining. The expression of cTnⅠ and TNF-α in serum was detected by ELISA and the expression of PI3K-γ and p-akt in cardiac muscles by Western blot． Results：Compared with those in Sep group，values of LVSP，LVEDP and LV±dp/dt-max at various time points were increased significantly（P=0.000），histopathological changes of cardiac muscles were relieved significantly，the expression levels of PI3K-γ in cardiac muscles were reduced significantly（P=0.000），the expression levels of p-akt protein were increased（P=0.000），and mouse serum cTnⅠ and TNF-α levels were decreased significantly（P=0.000，P=0.000） in Cur group. However，no significant difference was observed between the indexes in DMSO and Sep groups（P=0.586）． Conclusion：The protective effect of curcumin on cardiac muscles of SIMD mice is associated with the inhibition of PI3K-γ expression.

Abstract:Objective：To explore quercetin on ApoE -/-mice atherosclerosis formation and expression of stromal derived factor-1（SDF-1）/CXCR4，and to provide experimental basis for anti-atherosclerosis of the quercetin. Methods：Forty 6-week-old ApoE-/-mice were divided randomly into four groups：normal control，model group and experimental group（with low-dose，mid-dose and high-dose quercetin） and were randomly are sacrificed at the time of the 10 th week and 20 th week after the administration of the drugs respectively. SDF-1 and CXCR 4 protein and gene expressions were measured by ELISA，immunohistochemical technique and real-time PCR. Results：（1）HE staining demonstrated no plaque formation in normal group and lighter plaque formation in model group than in high-fat diet group. （2）According to immunohistochemical results at the same time points：in normal group，SDF-1 was mainly existed in endothelial cells and smooth muscle cells and CXCR4 mainly existed in endothelial cells；the expression was few and the staining was light；in model group，there were abundant expression of SDF-1 and CXCR4 in smooth muscle cells and foam cells，appearing in deep brown-yellow color；in experiment group，expressions of SDF-1 and CXCR4 were decreased in all three subgroups than in model group（P=0.010）. Statistical dif－ferences were found between low-dose and mid-dose groups and normal group（P=0.000）. According to immunohistochemi－cal results at the different time points，expression of SDF-1 in model group increased in time-dependent manner（P=0.000）. （3）ELISA results of SDF-1 and CXCR4 level in serum and real-time PCR results of SDF-1 and CXCR4 mRNA expression at the same time points：expression of SDF-1 and CXCR4 was the highest in model group（compared with other groups，P=0.000） and was the lowest in normal group. The expression of SDF-1 and CXCR4 progressively decreased with the increase of the dose of quercetin，especially there was no statistical difference in CXCR4 between high-dose group normal group（P >0.05）. At different time points，SDF-1 and CXCR4 in model group increased in time-dependent manner（P=0.00）. But no apparent time dependence occurred in experiment group and normal group. Conclusion：SDF-1/CXCR 4 may promote vascular smooth muscle cell proliferation and migration to the intima，so as to thicken the intima，form foam cell and lead to plaque formation. Quercetin may inhibit the expression of SDF-1 and CXCR4 and ApoE -/- mice atherosclerosis formation，which may be one of the mechanisms of its anti- atherosclerosis.

Abstract:Objective：To investigate the effect of angiotensin Ⅱ receptor blocker on atherosclerosis aortic endothelial cells through treating atherosclerotic rats with ARB. Methods：Totally 30 Wistar rats were randomly divided into 3 groups： model group，experiment group and control group with 10 rats in each group. Atherosclerosis rat model was established in model group by feeding high fat diet. Valsartan intervention was added in experiment group. After eight weeks，nitric oxide（NO），endothelin（ET），cytochrome-c（Cyt-c） and plasma endothelial lipase（EL） levels of aortic endothelial cells were compared. Results：At the end of the experiment，HE stain－ing of model group showed obvious plaque formation with a large amount of lipid infiltration. Immunohistochemical staining of Cyc-c showed that the positive rate of apoptosis of endothelial cells were higher in model group（36.85±12.45） than in control group（0.81±0.11） and experimental group（13.85±6.41）（P=0.000）. The positive rate of apoptosis of smooth muscle cells was higher than in model group（9.65±2.62） than in control group（0.06±0.01）（P=0.000），but did not statistically different from that of experimental group （7.85±1.34）（P=0.058）. Total cholesterol（TC） and low-density lipoprotein cholesterol（LDL-C） levels in model group and experi－mental group were increased significantly，however，did not statistically different those in control group（P=0.000）. There was statisti－cally significant difference in TC and LDL-C between model group and experimental group（P=0.000，P=0.002）. There was statistically significant difference in ET-1，NO，EL between model group，experimental group and control group（P=0.000）. There was statistically significant difference in ET-1，NO，EL between model group and experimental group（P=0.017，0.008，0.000）. Conclusion：Valsarta can protect function of endothelial cells during cell injury period. For patients with early atherosclerosis，Valsarta could protect the integri－ty of cells，reduce the apoptosis，playing a significant role in the prevention and treatment of disease.

Abstract:Objective：To investigate the effects of glyceryl trioleate on the proliferation of rat aortic smooth muscle cells（RASMC）. Methods：Cell culture was used in this experiment. Oil red staining was used to observe changes in cell morphology. The proliferation effect of glyceryl trioleate on RASMC was tested by MTT and flow cytometry. Results：Oil red staining results showed that RASMC lost its long fusiform appearance and somata got bigger. The higher the concentration of glyceryl trioleate，the more obvious the changes；no normal cell was existed in glyceryl trioleate with concentration of 2 000 mg/dl. Effects of glyceryl trioleate on the proliferation of RASMC were in time and dose relationship. Glyceryl trioleate inhibited the proliferation of RASMC under the condition of 24 h and ≤125 mg/dl while glyceryl trioleate promoted the proliferation of RASMC under the conditions of 24 h and ≥250 mg/dl as well as 48-72 h and ≤ 500 mg/dl. Glyceryl trioleate reached the highest proliferation rate of 115.9% under the condition of 24 h and 1 000 mg/dl，significantly different from that in control group（t=-3.74，P=0.002）. Glyceryl trioleate inhibited the proliferation of RASMC under the condition of 48-72 h and >500 mg/dl as well as 96-144 h and 62.5-2 000 mg/dl. The proliferation rate decreased by 42.7% and 65% compared with those in control group（t=13.08，P=0.000）（t=129.53，P=0.000） under the condition of 24 h，72 h and 2 000 mg/dl. Flow cycle results revealed that G0/G1-phase percentage reduced in glyceryl trioleate group than in control group while percentage of S-phase increased in glyceryl trioleate group than in control group. Apoptosis percentage decreased in glyceryl trioleate group than in control group in every time point except 24 h and 144 h. The apoptosis rate was 1.1%（F=14.39，P=0.019） and 0.7%（F=9.96，P=0.034） in glyceryl trioleate group，statistically different from those in control group. In addi－tion，the changes of cell proliferation and apoptosis were in the same direction. Conclusion：The effect of glyceryl trioleate on the proliferation of RASMC is bidirectional：low concentration and short time as well as high concentration and long time exhibit inhibit－ing effect while moderate time and concentration exhibit promoting effect. The results of cell proliferation cycle also support the pro－moting or inhibiting effect of glyceryl trioleate on the proliferation of RASMC. The direct cytotoxic effect，induced cell proliferation or apoptosis of high concentration lipids may involved in the regulation of vascular smooth muscle cells number and function.

Abstract:Objective：To investigate the effect and possible mechanism of flavone of Trollius chinensis Bunge on myocardial ischemia reperfusion injury（MI/RI） in rats. Methods：Fifty male SD rats were randomly divided into sham operation group，model group，posi－tive control Di’ao Xinxuekang group，nasturtium total flavonoids high and low dose groups（10 rats in each group）. One week before the surgery，different doses（50，100 mg/（kg?d）） were given to nasturtium total flavonoids high and low dose groups by intragastric administration，0.06 g/（kg?d）crude drug was given to Di’ao Xinxuekang group by intragastric administration and the same amount of physiological brine was given to the other two groups. The myocardial ischemia reperfusion injury model was established through oc－cluding the left anterior descending branch of coronary artery for 30 min and removing the ligation later to reperfuse for 120 min in vivo. The changes of ST segment on ECG during ischemia and reperfusion was observed. The activity of superoxide dismutase（SOD），glutathion peroxidase（GSH-Px） and the contents of malondialdehyde（MDA），lactate dehydrogenase（LDH），creatine kinas（CK） in serum were detected. The infarction area was determined by TTC staining and the myocardial apoptosis was determined by TUNEL method. Results：Levels of serum MDA，CK，LDH were decreased，content of SOD was improved，activity GSH-Px was enhanced，and infarction area and myocardial apoptosis rate were effectively reduced in nasturtium total flavonoids high dose group（CK：945.2±94.6；LDH：978.8±37.5；MDA：5.75±1.22；SOD：107.71±10.95；GSH-Px：1.62±0.45；infarction area：22.18±1.99） than in control group（P＜0.01）. Conclusion：The flavone of Trollius chinensis Bunge could protect myocardium from MI/R injury and the mechanism may be associated with scavenging oxygen free radicals，reducing lipid peroxidation，inhibiting myocardial apoptosis and reducing the leak out of myocardial enzymes.

Abstract:Objective：To observe the influence of apolipoprotein B-100（apoB-100） subunit poly peptide immune on atherosclerosis（AS） of ApoE-/-mice. Methods：ApoE-/-mice were randomly divided into three groups：group A（model control group） and group B（apoB-100 p45，apoB-100 p143 and apoB-100 p210 mixture group），group C（apolipoprotein B-100 intact peptide group），with 12 mice in each group. Mice of groups B and C were given polypeptide subcutaneous immunization while those in group A was given normal saline with same volume. All animals were executed after 25 weeks’ high fat diet. Enzyme linked immunosorbent assay was performed to detect specific IgG antibody. Total cholesterol（TC），triglyceride（TG） and low density lipoprotein cholesterol（LDL-C） high-density lipoprotein cholesterol（HDL-C） levels in serum of experimental mice were detected by biochemical analyzer. The ratio of AS plaque area against lumen area was measured by image analysis software after HE staining. Results：（1）After the first immu－nization，group B and group C had significant higher level of antibody than before（1∶962.5 vs. 1∶0.121，t=9.522，P=0.000；1∶1108.3 vs. 1∶0.121，t=7.531，P=0.000）. After the second immunization，group B and group C got significant higher antibody than before（1∶3582.9 vs. 1∶0.121，t=11.972，P=0.000；1∶3824.8 vs. 1∶0.121，t=8.220，P=0.000）. After the second immunization，group B and group C got higher level of antibody than first immunization（t=3.522，P=0.009；t=3.179，P=0.007）. （2）Serum TC（16.03±1.49），TG（1.72±0.12） and LDL-C（2.15±0.16） were significantly lower in group B than in group A（23.44±1.72，3.01±0.26，3.04±0.28） while HDL-C levels（2.87±0.17） was significantly higher in group B than in group A（1.82±0.11）（t=3.289，P=0.027；t=2.766，P=0.031；t=3.025，P=0.029，t=4.187，P=0.001）. TC（17.94±1.55），TG（1.88±0.15） and LDL-C（1.97±0.14） were significantly lower in group C than in group A while HDL-C levels（3.01±0.39） was significantly higher in group C than in group A（t=4.209，P=0.001；t=5.116，P=0.000；t=6.025，P=0.000；t=3.157，P=0.026）. （3）AS sever－ity was lighter in group B and group C than in group A and ratio of AS plaque area against lumen area was lower in group B and group C than in group A（4.59±1.41 vs. 17.6±5.36，t=3.465，P=0.021；3.87±2.05 vs. 17.6±5.36，t=2.992，P=0.030）. Conclusion：apoB-100 subunit poly peptide immune may regulate the formation of AS by adjusting the blood lipid metabolism of ApoE-/- mice.

Abstract:Objective：To investigate the influence of Shenmai injection（SMI） on mRNA expression of cytochrome P450（CYP450） in H9c2 myocardial cell. Methods：H9c2 cell was cultured by method of passage. Cell counting kit-8（ＣＣＫ－８） assay was used to detect the viability of H9c2 cells and lactate dehydrogenase（LDH） assay was used to detect the toxicity of H9c2 cells. The expression of CYP 2J3，CYP2C11，atrial natriuretic polypeptide（ANP） and brain natriuretic peptide（BNP） were measured by real-time PCR. Results：SMI could induce the expression of CYP 2J3 and CYP2C11 in H9c2 cell. In addition，SMI could induce the mRNA of ANP and BNP in a dose-dependent manner. Conclusion：SMI was widely used in the treatment of cardiovascular diseases. CYP2J3，CYP2C11，ANP and BNP mRNA expression maybe the new targets of metabolism.

Abstract:Objective：To explore clinical safety and efficacy of Parylene coating occluder in the treatment of children with congenial heart diseases（CHD） and in the block of nickel release into blood. Methods：A total of 23 patients with CHD who would done tran－scatheter closure were divided into parylene goup（A group） and traditional group（B group）. The devices of both group were supplied by Beijing Huayi Medical Equipment Company. There were 12 cases in A group，including 4 cases of ventricular septal defects（VSD） and 8 cases of patent ductus arteriosus（PDA） and there were 11 cases in B group，including 3 cases of VSD and 8 cases of PDA. All patients were informed consent form signed by his guardian. All cases in both groups completed percutaneous transcatheter closure therapy under X-ray，electrocardiography and transthoracic echocardiography，and were followed-up regarding clinical symptoms，hepatic and renal function，blood routine，echocardiography，electrocardiography，chest X-ray and nickel concentration before therapy，1 d post therapy，1 month post therapy，3 months post therapy and 6 months post therapy respectively. Results：All treatments in both parylene group and tradional group were successful，with successful rate of 100%（23/23）. Little residual shunt was observed in one case in parylene group just after the treatment but disappeared at 6 month after the treatment. No case had complications of mechani－cal hemolysis，devices shifting and falling off and arrhythmia. There was no significant difference between two groups in clinical symptoms and signs，hepatic and renal function（P=0.819，P=0.418，P=0.991，P=0.828），routine blood examination（P=0.521，P=0.239，P=0.088），echocardiography，transthoracic electrocardiography（P=0.249，P=0.239，P=0.213，P=0.071，P=0.397），chest X-ray（P=0.537 and P=0.114） and nickel concentration（P=0.797） at each follow-up time point. Conclusion：There is no significant difference between Parylene coating occluder and traditional occluder in effectiveness and safety in the treatment of child CHD and in the block of nickel release into blood.

Abstract:Objective：To observe the relationship between heart rate variability（HRV） and the sites of acute myocardial infarction（A－MI），and to observe the relationship between HRV and malignant ventricular arrhythmia（MVA） following AMI. Methods：Totally 120 patients with AMI in our hospital were selected. According to the classification of ventricular arrhythmia，patients was divided into two groups：MVA groups and non MVA（NMVA） groups. According to the infarction parts，patients was also divided into two groups：ante－rior wall infarction and non anterior wall infarction groups. HRV were obtained by the 24h-Holter. Results：Standard deviation of the average NN intervals（SDANN），standard deviation of the average NN intervals（SDANN），SDNNI，square root of the mean squared differences of successive NN intervals（RMSSD），low-frequency（LF），high-frequency（HF） and LF/HF were lower in MVA group than in NMVA group and the P values were 0.000，0.004，0.001，0.000，0.000，0.001 and 0.017，respectively. But there was no difference between the two groups in very low-frequency（VLF） （P=0.714）. Values of SDNN（P=0.000），SDANN（P=0.000），SDNNI（P=0.000），LF（P=0.000），LF/HF（P=0.013） were lower in anterior wall infarction group than in non anterior wall infarction groups. RMSSD（P=0.000） and HF（P=0.000） values were higher in anterior wall infarction group than in non anterior wall infarction group. And there was no difference between the two groups in VLF（P=0.064）. Conclusion：HRV is correlated with MVA following AMI. HRV might correlate with the site of myocardial infarction. Anterior wall infarction may be led by the increased sympathetic nervous activity，while non anterior wall infarction may be led by the decreased vagal activity.

Abstract:Objective：To summarize the clinical features，diagnosis and treatment of congenital vascular ring in children. Methods：Clinical data of 60 patients with congenital vascular rings in Children’s Hospital of Chongqing Medical University from January 2003 to January 2013 were retrospectively studied. All children underwent computed tomography angiography（CTA），echocardiography，gastrointestinal barium meal，fiberoptic bronchoscopy. Results：Sixty cases including 40 males and 20 females，aged from 1 day to 6 years，were enrolled in our study. The most frequent diagnosis was pulmonary artery sling（25 cases，41.67%），followed by double aorta arch（21 cases，35%） and right aortic arch with left ductus arteriosus（12 cases，20%）. Twenty-eight cases（46.7%） combined with heart malformations. Forty five cases（46.7%） combined with tracheobronchial stenosis，10 cases combined with esophageal stricture.The diagnosis rate of CTA was 81.82% and that of echocardiography was 53.33%. 52 cases（87%） had a history of respiratory symptoms including difficulty in breathing，recurrent cough and wheezing，and recurrent respiratory tract infections. Forty patient who underwent surgery included left pulmonary artery transplantation（15 cases），double aortic arch devascularization（12 cases），artery catheter/ligament cut-off（12 cases），left subclavian artery occlusion（1 case）. Seven patients died. Vascular ring combined with complete tracheal ring was a risk factor for patients underwent surgery（P<0.05）. Patients underwent surgery remained respiratory symptoms for up to 6 months，however，they had significant improvement in the postoperative period. Conclusion：Children with recur－rent respiratory symptoms such as recurrent respiratory tract infections，chronic cough and wheeze，dysphagia should be examined for the presence of congenital vascular ring. Echocardiography combined with CTA is the best way to diagnose vascular ring. Early cor－rect diagnosis and timely surgical treatment are the keys to survival.

Abstract:Objective：To assess the efficacy and safety of different maintenance doses of clopidogrel for patients after percutaneous coronary intervention（PCI） by a meta-analysis and to provide some advices for clinical therapy. Methods：According to the methods of evidence-based medicine，randomized controlled trials（RCTs） about the different maintenance doses of clopidogrel using on pa－tients after PCI were searched. Data were extracted into a designed form and the quality of selected articles was analyzed. The Rev Man 5.0 software was used for data analysis. Results：Thirteen RCTs containing 2 883 patients were included. The meta-analysis showed that 150 mg clopidogrel significantly inhibited platelet aggregation（PA） and reduced major adverse cardiac events（MACE） incidence than 75 mg clopidogrel（MD=-12.20，95%CI=-13.77 to -10.63，P=0.000）（RR=0.41，95%CI=0.27 to 0.63，P=0.000）. Finally，No obvious difference was found in major bleeding（RR=1.61，95%CI=0.90 to 2.87，P=0.110） or minor bleeding（RR=1.19，95%CI=0.87 to 1.62，P=0.270） between the two groups. Conclusion：Clopidogrel with dose of 150 mg is superior to clopidogrel with dose of 75 mg in inhibiting PA and reducing MACE for patients after PCI without bleeding risk.

Abstract:Objective：To evaluate the efficacy and safety of genotype-guided warfarin in preventing and treating thromboembolic dis－ease using Meta-analysis. Methods：PubMed database，Cochrane Library，Wanfang，VIP and CNKI were systemically searched for lit－erature of genotype-guided warfarin in preventing and treating thromboembolic disease. The searching date was up to January 1，2014. The data extraction and methodological grading were performed independently by two authors. RevMan version 5.2 was used for sta－tistical analysis. Results：A total of 11 randomized controlled trials（RCTs） were included in systematic review and 10 RCTs（2 905 cases） were quantitatively analyzed. The results of Meta-analysis showed that there was no significant difference between genotypic warfarin-dosing group and control dosing group in the aspects of percentage of time in the international normalized ratio therapeutic range（SMD=0.11，95%CI＝-0.06 to 0.29，P=0.21），patients with stable dose（RR=1.13；95%CI＝1.00 to 1.28，P=0.05），over coagulation（RR=0.95，95%CI＝0.83 to 1.08，P=0.44），bleeding（RR=0.89，95%CI＝0.78 to 1.01，P=0.08），thromboembolism（RR=0.61，95%CI＝0.30 to 1.23，P=0.17）. There was no significant difference between genotypic warfarin-dosing group and control dosing group in per－centage of time in the INR therapeutic range and patients with stable dose. The sensitivity analysis of outcomes showed that the re－sults were stable and reliable. Conclusion：The evidence of superiority in efficacy and safety of genotype-guided warfarin in prevent－ing and treating thromboembolic disease is still insufficient.

Abstract:Objective：To systematically review the efficacy and safety of tolvaptan for the patients with heart failure. Methods：Databases of PubMed，Embase，Web of Science，The Cochrane Library，CBM，CNKI，VIP and WanFang Data were electronically searched for rel－evant studies from inception to October 2013. Two reviewers independently screened literature，extracted data，and assessed the meth-odological quality of the included studies according to the inclusion and exclusion criteria as well as the methods recommended by the Cochrane Collaboration. Then，Meta-analysis was performed using RevMan 5.2.3 software. Results：Eight trials involving 4 908 patients were included. The results of Meta-analysis showed that tolvaptan was more effective than placebo in increasing the serum sodium concentration（MD=3.63，95%CI=3.32 to 3.94，P=0.000），and in decreasing body weight（MD=-0.81，95%CI=-0.92 to -0.70，P=0.000）. In addition，the incidence of adverse events was significantly lower in the placebo group（OR=0.27，95%CI=0.20 to 0.38，P=0.000）. Conclusion：Tolvaptan is effective for patients with heart failure and hyponatremia and patients can tolerate the adverse events well.

Abstract:Objective：To evaluate the efficiency and safety of transcatheter closure and surgical repair for atrial septal defect（ASD） using systematic review method and to provide references for clinical treatment. Methods：The CBM，CNKI，WanFang Med Online and VIP were searched for all controlled trials. Screening，quality evaluation and information extraction were carried out on the studies according to including and excluding standard. The software RevMan 5.2 was used for data analysis. Results：Thirteen included studies were not randomized controlled trials，984 cases in intervention group and 890 cases in surgery group. The combined results showed that the procedural success rate of transcatheter closure group was lower than that of surgery group（13 controlled trails，96.64% vs. 99.66%，RR=0.97，95%CI=0.96 to 0.98，P=0.000）. Although the instant residual shunt rate was higher in transcatheter closure group than in surgery group（10 controlled trails，2.31% vs. 1.70%，RR=1.45，95%CI=0.75 to 2.82，P=0.270），the total complication rate was lower in transcatheter closure group than that in surgery group（12 controlled trails，6.07% vs. 20.26%，RR=0.29，95%CI=0.22 to 0.39，P=0.000）. Conclusion：Transcatheter closure of patent ductus arteriosus is an ideal procedure within acceptable limits owing to its reliability，safety，min-invasiveness and short hospitalization.

Abstract:Objective：To investigate hepatitis B virus（ＨＢＶ） DNA levels with polymerase of HBV genotypes A，B，C and D. Methods：The method of restriction digestion and ligation-independent cloning（RLIC） and trans-complementation by HBV polymerase was used to express and test HBV DNA levels with four genotypes. Results：（1）HBV expressed again after HBV polymerase trans-complementa－tion. HBV DNA：A=（63.03±8.03）×105 copies/μl，B=（23.23±3.53）×105 copies/μl，C=（17.63±1.25）×105 copies/μl，D=（75.73±9.43）×105 copies/μl. （2）There were differences in HBV DNA levels among different genotype polymerases，F（4，10）=91.88，P＝0.000. （3）HBV DNA levels were higher in genotype D and A than in genotype B and C，P（A，B）=0.001，P（A，C）=0.00１，P（B，D）=0.00１，P（C，D）=0.00１. Conclusion：HBV DNA levels with polymerase of hepatitis B virus genotypes A，B，C and D were different；the mechanism of differ－ences remains to be further studied.

Abstract:Objective：Streptococcus pneumonia is a major cause of several diseases. To express and purify the heat shock protein GrpE from Streptococcus pneumonia in order to uncover the infectious mechanism. Methods：Being amplified by PCR，the open reading frame of GrpE was subcloned into pW28 and expressed in escherichia coli（E.coli） B834. The bacterial protein was purified by nickel chro－matography column and anion-exchange chromatography column subsequently. The aggregation of GrpE in solution was analyzed by gel filtration column（Hiload Superdex 75） and its thermal stability was characterized with thermal shift assay（TSA） method. Results：The GrpE protein was expressed in E.coli B834 as soluble. The purified protein with high purity of 95.0% exhibited homodimer in solutions. The recombinant GrpE protein presented relative stabilization in a solution at pH 6.0 and 20 mmol/L NaCl. Conclusion：The GrpE protein with high purity was expressed in E.coli B834 and its thermal stability was determined with TSA method.

Abstract:Objective：To prepare urate oxidase lipid nanoparticles by Tricine-NaOH buffer（UTLNs） and then to study the in vitro ac－tivity and stability of free UOX and UTLNs. Methods：UTLNs was prepared by reverse-phase evaporation method. The optimum tem－perature，optimum pH，thermal stability，storage stability，pH stabilities and proteolytic stabilities of free UOX and UTLNs were mea－sured. Results：The optimum temperatures for free UOX and UTLNs were both 40 ℃. The optimum pH for free UOX and UTLNs were 8.5 and 8.0，respectively. UTLNs had significantly better stability than free UOX in vitro. Conclusion：UTLNs not only improved the activity but also significantly enhanced the stability of free UOX in vitro.

Abstract:Objective：To probe into rule of skin development and aging by extracting corner density and rimae cutis area in skin im－age. Methods：The amplificatory skin images on the middle of inner forearm of healthy people were collected by digital microscope. High technologies of image processing including image segmen－tation and corner detection were applied to extract quantitative data of the two parameters. Skin texture development rules were analyzed by using statistics methods of correlation analysis，variance analysis and regression analysis. Results：The experi－ment data showed that the area of rimae cutis increased with age（male：r=0.950，P=0.000，female：r=0.960，P=0.000）. The density of corner in skin image was decreased with age（male：r=-0.958，P=0.000；female：r=-0.969，P=0.000）. Conclusion：The method of this paper is effective in exploring the skin texture development rule. The research helps to assess the effect of cosmetic objectively and improve cosmetic operations with quantify data. The research also can be applied to forensic aging identification.

Abstract:Objective：To investigate the changing trend of hepatitis B virus（HBV） “a” determinant quasispecies in 5 children who failed to responded to hepatitis B vaccine and their mothers. Methods：Five children who developed into chronic HBV infection after receiving hepatitis B vaccine and their respective mothers were enrolled into the research. The full HBV genome was amplified by polymerase chain reaction（PCR） and the sequences were determined by Solexa sequencing technology. Results：The sequence homology between paired mother and child was beyond 99%. The HBV genotype in 5 pairs of mother-child was mixture of B and C. Among them，4 pairs had dominant B while the other 1 pair had dominant C. The dominant HBV genotype was identical between paired mothers and children. Significant complexity positions could be found in every immunized child. There were 10 significant complexity positions in “a” determinant region in 5 pairs of mother-child；aa126 and aa143 were observed only in one child. And one child had G145R mutant. Conclusion：“a” determinant quasispecies can be found in children who failed to responded to hepatitis B vaccine. The mutant strain in child may be transferred from her mother.

Abstract:Objective：To analyze changes of protein expression in rat transplant kidney by proteomics technique and to search and identify differential expression proteins which are related with acute rejection. Methods：All transplant rats were divided into two groups： experimental group（F344→Lewis） and control group（F344→F344）. Rat models of allogene renal transplantation were estab－lished respectively and allograft specimens were obtained on 7 d post the transplantation. Total proteins of rat transplant renal tissues were separated by two-dimensional gel electrophoresis（2-DE）. Differential expression proteins were analyzed and then identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry（MALDI-TOF-MS）. Results：Averages protein spots in ex－perimental group and control group were 554.0±34.0 and 542.0±21.0 respectively. Compared with those in control group，37 dif－ferentially expressed proteins were screened in experimental group，of which 29 were identified by peptide mass fingerprint and 6 were founded by bioinformatics in SwissProt data base. Conclusion：Six differential expression proteins which may correlate with acute rejection of renal allograft are identified by comparative proteomics and might become possible biological marker of acute rejection of renal allograft.

Abstract:Objective：To develop a forensic medical expert system assiting crime scene investigation. Methods：NET development platform was taken as the basis；methods of knowledge aided design system（KADS） was used，and the domain knowledge was classi－fied into three levels：domain，inference and task. The data base was constructed with SQL SERVER. The ontology knowledge base was constructed with PROT?魪G?魪. The core of inference model was constructed with CLIPS. LOADRUNNER was employed to analyze the system in order to refine and improve the database and inference mechanism. Results：The forensic expert system can produce in－structive opinion through gathering information from the scene and autopsy outcome. By simulating inference，the system can provide ideas related to cause of death，death time，manner and nature of death. Furthermore，the system can provide consultation on the num－ber of suspects and manner of a crime. Conclusion：The expert system can provide obejctive opinions for practical work. It also can manifest the truth and the crediblily of evidences. Moreover，it can provide simulation training program for forensic medicine students.

Abstract:Objective：To study accuracy of 2-D matrix Detector729 in dosimetric measurement and its application in radiotherapy quality control. Methods：Tests and output factor measurement were performed to evaluate and compare the accuracy of Detector729 taking 0.6 cm3 ion chamber under the X-ray as reference. Detector729 was used as a tool to verify dosimetric distribution for inten－sity modulated radiation therapy（IMRT）. Results：The scale factor of Detector729 from the reference ionization chamber was 0.991，and the comparison results showed the maximum deviation of measuring point dose was 0.57%. Meanwhile，under the square fields of 4 cm×4 cm-20 cm×20 cm，the estimated output factor matched very well with the reference ion chamber measurements. Conclusion：With high accuracy and reliability，Detector729 can be used in dosimetric measurement and quality control of radiotherapy and pro－vide theoretical basis for the standard use of radiation dosimetric measurement instruments.

Abstract:Objective：To explore the value of four indicators of in ultrasound diagnosis for rheumatoid arthritis（RA）. Methods：Totally 77 suspected RA patients were enrolled and divided into musculoskeletal ultrasound（MSUS） group and clinical group. MSUS and clinical methods were used respectively to diagnose RA using double-blind method. MSUS was used to detect seven joints including ipsilateral wrist，the second and third metacarpophalangeal joints，the second and third proximal interphalangeal joint，and the second and fifth metatarsophalangeal joints. Synovial hyperplasia，the synovial blood signal，bone erosion and joint effusion of ultrasound were used to diagnose synovial lesions of RA. Both MSUS method and clinical method were compared by comparative analysis. At the same time，these four indicators were scored by the serological indicators. Results：Fifty-five cases of RA and 22 cases of non-RA were di－agnosed by MSUS while 53 cases of RA and 24 cases of non-RA were diagnosed by clinical method. There was no statistical signifi－cance between MSUS method and clinical method in diagnosing RA（P=0.774）. There was a close correlation between sum scores of synovial blood flow，sum score of effusion and erythrocyte sedimentation rate（r=0.739，P=0.000；r=0.564，P=0.000）. Conclusion：Four indicators of MSUS accords with clinical method in the diag－nosis of RA. There is a close correlation between sum scores of synovial blood flow，sum score of effusion and serological indi－cators. MSUS，as a screening method for RA，provides more evi－dences for the diagnosis for RA，therefore should be widely ap－plied.

Abstract:Objective：To evaluate the differential diagnosis of 3.0T dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI） combined with diffusion weighted imaging（DWI） in the characterization of breast lesion. Methods：A total of 73 patients with breast diseases（37 benign lesions and 42 malignant lesions） were retrospectively analyzed. All lesions were examined with 3.0T DCE-MRI and DWI（b=0.800 s/mm2） before the histopathological demonstration. The lesion morphology，edge enhancement and curve pattern were analyzed using integral method and statistical method. The Fisher score，sensitivity，specificity，accuracy，positive likelihood ra－tio，and negative likelihood ratio of DWI and combined method in the diagnosis of breast lesions were compared. Results：The average apparent diffusion coefficient（ADC） of benign and malignant lesions were（1.49±0.34）×10-3 mm2/s and（1.01±0.29）×10-3 mm2/s.The threshold of ADC between benign and malignant lesions was 1.15×10-3 mm2/s by receiver operating characteristic curve. The sen－sitivity，specificity，accuracy and positive likelihood ratio，negative likelihood ratio of ADC were 83.3%，83.8%，83.5%，0.199，5.142.The sensitivity，specificity，accuracy and positive likelihood ratio，negative likelihood ratio of DCE-MRI were 97.6%，78.4%，88.6%，0.031，4.519. The sensitivity，specificity，accuracy，positive likelihood ratio and negative likelihood ratio of DCE-MRI combined with DWI were92.9%，91.9%，92.4%，0.077，11.469. Conclusion：DCE-MRI combined with DWI is of high diagnostic value as it has higher scores in sensitivity，specificity，accuracy，positive likelihood ratio and negative likelihood ratio in the diagnosis of breast diseases.

Abstract:Objective：To investigate the influence of bowel preparation on uterine diffusion weighted imaging magnetic susceptibility artifact. Methods：Totally 60 healthy women（ranged between 23 to 45 years old） were randomly divided into two groups：non bowel preparation group and bowel preparation group，30 subjects in each group. Then every subject was scanned for T2WI（axial and sagit－tal plane） and DWI. Fnally every image was evaluated by two doctors in a double-blind way. Results：In non bowel preparation group，average occurrence rate of air predominance was 65.00% and occurrence rate of fluid predominance was 35.00%. In bowel prepara－tion group，mean occurrence rate of air predominance was 23.33% and occurrence rate of fluid predominance was 76.67%. There were significantly statistical differences in two doctors’ evaluation between two groups（P1=0.002，P2=0.004）. The average positive rate for uterine DWI susceptibility artifact was 82.91% when fluid predominating in the intestinal tract and the average positive rate for uterine DWI susceptibility artifact was 13.46% when air predominating in the intestinal tract. There were significantly statistical differences in two doctors’ evaluation of magnetic susceptibility artifact between two groups（P1=0.000，P2=0.000）. Conclusion：Bowel preparation can decrease susceptibility artifact before uterine DWI examination，and then improve the quality of uterine DWI，which is beneficial for the uterine histological study as well as the diagnosis，monitoring and assessment of uterine diseases.

Abstract:Objective：To explore the feasibility of dual-source spiral CT with high-pitch flash spiral mode as well as time-density curve in diagnosing the clinically suspected pulmonary embolism（PE）. Methods：Sixty patients planed to receive CT pulmonary an－giography（CTPA） were randomly divided into two groups. Routine scan and bolus tracking monitoring were used in control group，while dual-source spiral CT with high-pitch flash spiral mode as well as time-density curve was used in experimental group. Contrast agents Iodine diftler with the concentration of 400 mgI/ml was applied in both groups. The parameter of CT scanning was the same in both groups. All CT original dates were transferred to Siemens workstation and were post-processed by VR，MIP，MPR and CPR tech－nology. The CTPA image quality was evaluated based on score of image quality，CT value，and contrast to noise ratio（CNR）. Results：All patients in two groups completed CTPA successfully. There was no difference in baseline characters including sex，age，height and weight between the two groups（P=0.752，0.605，0.319，0.523）. CNR of experimental group was higher than that of control group（P=0.028，0.030，0.001，0.012，0.020）. There was no difference in CT value of pulmonary artery trunk，RSPA，RIPA，LSPA and LIPA between the two groups（P=0.362，0.986，0.373，0.584，0.931），but CT value of the ascending aorta，RSPV，RIPV，LSPV and LIPV were lower in experimental group than in control group（P=0.000，0.001，0.000，0.003，0.000）. Scores of image quality were better in experimental group than in control group（χ2=12.25，P=0.016； χ2=7.53，P=0.023）. Both the contrast agents（24 ml vs. 50 ml） and radi－ation dose[（5.27±1.94） mSv vs. （7.30±2.73） mSv] were lower in experimental group than in control group（P=0.011）. The scanning time was significantly shorter in experimental group than in control group[（0.94±0.07） s vs. （4.71±0.37） s，P=0.000）]. Conclusion：CTPA with flash spiral mode and time-density curve could col－lect the satisfied image，reduce patients’ contrast agents and radiation dose，and decrease the breathless time.

Abstract:Objective：To analyze the characteristics of gastroscope and Doppler ultrasonography in the abdominal type Henoch-Schonlein purpura（HSP） and to investigate its clinical value for early diagnosis. Methods：Retrospective review was made on the gas－troscope and Doppler ultrasonography features of 32 children with abdominal type HSP who had been hospitalized from Januanry 2010 to October 2013. Gastroscope and Doppler ultrasonography were performed on all patients. All cases had acute abdominal pain without cutaneous purpura before gastroscope and doppler ultrasonography. Results：Abnormal finding of gastroscope was observed in 29 cases（90.6%）. The gastroscopic characteristics of stomach and duodenal mucous were congestion，swelling，hemorrhage，erosion and even ucler. Mucosal lesions became more serious in the descending duodenum. Abnormal finding of Doppler ultrasonography was ob－served in 25 cases（78.1%）. The characteristics of the injured wall was single or multiple areas of intestinal wall thickening with plenty of blood flow. Of the 35 children，23（71.9%） had both gastroscope and Doppler ultrasonography abnormal findings；cutaneous purpu－ra appeared on（9.780±3.190） d after abdominal pain；imaging results were obtained on（6.130±1.914） d after abdominal pain，for－warding clinical diagnosis of HSP for 3.65 d（t=9.23，P<0.01）. Conclusion：Both gastroscope and Doppler ultrasonography abnormal findings are common in HSP. Gastroscope combined with doppler ultrasonography is useful for early diagnosis and treatment of ab－dominal type HSP effectively.

Abstract:Objective：To apply the echo-tracking（ET） to evaluate the peripheral artery function，to explore the influencing factors of detecting parameters of patients with type 2 diabetes and to provide scientific basis for early clinical prevention and treatment of dia－betic patients with peripheral vascular disease. Methods：Totally 128 patients with type 2 diabetes were taken as diabetic group and 120 health volunteers were recruited as control group in this study. ET technology was used to detect pressure-strain elasticity coeffi－cients（Ep），stiffness parameter β（SPβ），arterial compliance（AC），pulse wave velocity β （PWVβ），augmentation index（AI） and sys－tolic diameter（Ds），diastolic diameter（Dd） and intima media thickness（IMT） both in diabetic group and control group. Vascular function in the carotid，femoral and brachial artery was quantitatively evaluated and influencing factors of ET were analyzed by using basic information of the cases. Results：Values of Ep，SPβ and PWVβ in the arotid，femoral and brachial artery in diabetes group were significantly higher than those in controls（P<0.05）. AC values in the arotid，femoral artery were significantly lower in diabetes group than in control group（P<0.05）. Among the factors of age，duration of diabetes，fasting glucose，2 h postprandial blood glucose，triglycerides，total cholesterol and other factors，the main influencing factors were age，duration and total cholesterol. Ep，SPβ and PWVβ were positively correlated with age and diabetes duration（P<0.05）. AC values were negatively related with age and duration（P<0.05） but were positively correlated with total cholesterol（P<0.05）. Also，AI values were positively correlated with age（P<0.05）. Conclusion：ET can be used for the evaluation of type 2 diabetes patients with peripheral atherosclerosis，and the main influencing factors of its detection indicators are age and disease duration. This method can accurately evaluate the functional or pathological changes in type 2 diabetes patients with peripheral atherosclerosis and it is of great significance for early prevention and treatment of the diabetes.