Volume 90  ·   Issue 20  ·  2010

Angiotensin converting enzyme inhibitor (ACEI), β-blockers and diuretics as the core drugs for chronic heart failure (HF) have matured and are not expected to change significantly in recent years. In order to further improve the quality of life of patients, reduce repeated hospitalization and improve long-term prognosis, the issue of improving the self-care ability of patients with HF must be put on the agenda [1].

The results of a retrospective cohort study conducted by Craig J Currie and others at Cardiff University in the United Kingdom showed that patients with type 2 diabetes who controlled glycosylated hemoglobin (HbA1c) at about 7.5% had the lowest risk of death, and that too low control of HbA1c increased the risk of death<The Lancet>Journal (2010, 375:481-489).

Dual antiplatelet therapy (aspirin plus clopidogrel) is the standard treatment in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI), but it increases the risk of digestive events. Therefore, the guidelines recommend proton pump inhibitors (PPI) to prevent digestive events in patients receiving double antiplatelet therapy [1].

At present, the high rehospitalization rate and mortality rate of cardiovascular diseases in patients with chronic heart failure are still important issues to be solved urgently. According to statistics, there are about 5 million patients with heart failure in the United States, and it is increasing year by year. About 550,000 new cases are added every year, and about 290,000 patients die from heart failure every year [1].

Objective To evaluate the cardiopulmonary exercise capacity in patients with chronic heart failure (CHF). Methods Cardiopulmonary exercise testing on bicycle ergometer was performed in 74 age, gender and BMI-matched patients. There were 37 patients with LVEF<0.45 in CHF group and another 37 patients with LVEF>0.50 in control group. VO2AT, VO2Peak, Load AT, Load peak and VE/VCO2 slope were measured and compared. Results(1)VO2AT, VO2Peak, Load AT and Load peak were all significantly reduced in patients with CHF as compared with controls [VO2 AT:(11.3±2. 3)ml ·kg-1·min-1 vs(12.8±2.5) ml·kg-1·min-1, P<0.05; VO2peak: (15.2±4. 3) ml·kg-1·min-1 vs (17.3±3.9)ml·kg-1·min-1, P<0. 05;Load AT: (25.2±18.8)J·s-1 vs(45. 6±18. 7)J·s-1,P<0.01; Load peak:(54.9±22.5)J·s-1 vs(80.3±21.6)J·s-1,P<0.01]:(2) VE/VCO2 slope increased in patients with CHF as compared with controls[(36. 7±6.7)vs(30. 3±4. 3),P<0. 01];(3) None of VO2AT, VO2Peak, Load AT, Load peak or VE/VCO2 slope was correlated with LVEF [(r=0.054,P>0.05);(r=0.03,P>0. 05); (r=0.310,P>0.05); (r=0. 174,P>0. 05); (r=-0.203,P>0. 05)]; VO2AT, VO2Peak, Load AT and Load peak were all correlated negatively with a higher NYHA grade [(r=-0.477, P<0.01);(r=-0.591,P<0.01); (r =-0.640,P<0.01); (r=-0. 672, P<0. 01)]; VE/VCO2 slope correlated positively with a higher NYHA grade (r=0.652,P<0.01);None of VO2AT,VO2Peak,Load AT,Load peak or VE/VCO2 slope was correlated with LVMI [r=0.045,P>0.05);(r=-0.017,P>0.05);(r=-0.214,P>0.05);(r=-0.123,P>0.05);(r=0.106,P>0.05)1.Conclusion (1)Cardiopulmonary exercise capacity is reduced in CHF patients.(2)None of VO2AT,VO2Peak,Load AT,Load peak and VE/VCO2 slope is correlated with LVEF;VO2 AT,VO2 Peak,Load AT and Load peak all correlate negatively with the higher NYHA grade;VE/VCO2 slope correlates positively with a higher NYHA grade;None of VO2 AT,VO2 Peak,Load AT,Load peak or VE/VCO2 slope correlates with LVMI.An analysis of gas metabolism is a safe,accurate and scientific testing method of exercise tolerance.

Objective To investigate whether the gene transfer of phospholamban antisense RNA could inhibit remodeling and preserve cardiac function after myocardial infarction. Methods Wistar rats received a ligation of left coronary with a direct intramyocardial injection of phospholamban antisense RNA eukaryon vector PcDNA4-asPLB. The cardiac function, hemodynamics and ventricular geometry of three groups (shame, saline injection and PcDNA4-asPLB injection) were studied by echocardiography and left ventricle hemodynamic recording. The levels of phospholamban (PLB) and sarcoplasmic reticulum Ca2+-ATPase (SERCA2a) were analyzed by Western blot and the expressions of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) examined by RT-PCR. The histological study was performed to evaluate the collage content and cardiomyocyte fiber size. Results The PcDNA4-asPLB injection group had significantly better systolic cardiac function and diastolic function [LVEF(39. 4±7. 8)% vs (30. 9±7.4)%, P<0.05; dp/dt Max (1545 ±127) mm Hg·s-1 vs (1172±91) mm Hg·g-1, P<0.05)]. Compared with saline injection, the PLB expression was inhibited by 50% in PcDNA4-asPLB injection group (PLB/β-actin ratio, 0. 28±0. 07 vs 0. 57±0. 11, P<0. 05) and the function of SERCA2a was enhanced [(1.47±0.21) μmol·min-1·g-1 protein vs (0.34±0.13)μmol·min-1·g-1 protein, P<0.05]. The expressions of ANP and BNP in the saline injection group were elevated as compared to those in the PcDNA4-asPLB injection group. Histological study also showed that the collage density and thecardiomyocyte fiber size in the saline injection group were worse than those in the PcDNA4-asPLB injection group.Conclusion Intramyocardial injection of phospholamban antisense RNA eukaryon vector PcDNA4-asPLB after myocardial infarction results in PLB expression inhibition.attenuates ventricular remodeling and improves systolic and diastolic cardiac functions.

Objective To investigate the importance of abnormal glucose metabolism in a chronic heart failure (CHF) population. Methods A total of 444 patients were enrolled sequentially for decompensated CHF from January 1st, 2005 to December 31st, 2007 at our department They were divided into diabetic (n=153, 34.5%) and non-diabetic groups (n=291, 65. 5%). Among the non-diabetics, there were 113 (25.4%) with impaired fasting glucose (IFG) (FPG 5.6 -6.9mmol/L) and 178 (40.1 %) with normal glucose levels. All subjects received a follow-up to record their clinical status, biochemical parameters and end-point events (all-cause death in one year) . And the correlations of abnormal glucose metabolism and end-point events were analyzed. Results Among these patients, 83 (17. 1%) died in 1 year, 31 (7. 0%) were lost to follow-up; among 83 dead patients, 15 (8. 4%) were within normal glucose levels, 34 (21. 2%) with IFG and 44 (28. 8%) with diabetes mellitus. Compared with normal glucose level patients, the mortality rates of diabetes mellitus and IFG patients were higher (P<0.01). There was no significant difference in mortality rate between diabetes mellitus and IFG patients. After adjustment for other prognostic attributes (age, sex and etc.), diabetes mellitus was a predictor of 1-year allcause mortality (OR=2.383, 95%CI: 1.317 to 4.312; P=0.004). In diabetics, the mortality of the higher glucose level group (FPG>7.0 mmol/L) was 30.4% and that of the lower glucose level group (FPG≤7.0 mmol/L) 27.4%. And there was no significant difference (P>0.05). The FPG level could not predict the 1-year all-cause mortality. In non-diabetics, the mortality of IFG group (FPG 5.6 -6.9 mmol/L) was significantly higher than that of normal glucose levels group (21.2% vs 8.4%, P<0.01). IFG status predicted 1-year all-cause mortality (OR=3.564, 95%CI: 1.494-8.497, P=0.004). The FPG level was also associated with the 1-year all-cause mortality (OR=1.791, 95% CI: 1.090-2.943, P=0.021) . Conclusion Diabetes mellitus is an independent predictor of 1-year all-cause mortality for CHF. And IFG and a higher FPG level are associated with 1-year all-cause mortality for CHF without diabetes mellitus.

Objectives To determine the impact of BMI on clinical outcome in patients with heart failure underwent coronary revascularization. Methods The DESIRE-plus (Drug-Eluting Stent Impact on Revascularization-plus) was a single-center registry of coronary revascularization in our institution between July 1,2004 and September30 , 2005. We analyzed heart failure patients with the complete data of body mass index (BMI) data from the DESIRE-plus trial and grouped them by BMI (normal BMI group, BMI＜24; overweight group, BMI 24-27.9; obesity group, BMI≥ 28). Total mortality, cardiac mortality and MACCE including death, neo-myocardial infarction, stroke, re-revascularization were recorded. We evaluated risk estimates for three bodyweight groups. Results 1010 patients were included in the study (295 in normal BMI group; 495 in overweight group and 220 obesity group). Median follow-up was 542 days. Overweight and obese patients were younger (59. 3 ± 10. 14 years, 58. 6 ± 10. 30 years vs 62. 6±9. 93 years, P＜0. 01) and had a significantly higher incidence of hypertension (61.2, 66. 8% vs 52. 5% , P=0. 017) , stable angina pectoris (21. 2% , 23. 7% vs 17. 0% ,P=0.05) and higher triglyceride[(1. 90±1.05) mmol/L,( 2. 10±1.12) mmol/L vs (1.48±0.92) mmol/L, P＜0.01)] , fasting blood glucoselevel [(6.07±2.09 )mmol/L, (5.96±1.53) mmol/L vs (5.67±1.92 )mmol/L, P=0.021) , blood creatinine (84. 9±21. 7) μmol/L, (90. 2±30. 9)μmol/L vs (82. 2±25. 8)μmol/L,P=0. 002] compared with normal BMI patients. Multivariate Cox regression model showed obese patients had an decreased hazard risk (HR) for total mortality (0. 285, 95% CI 0. 104-0. 777) and MACCE (0. 596, 95% CI 0.401-0.885) compared with those for patients with normal BMI, overweight patients had no increased risk for total mortality (HR 0.769, 95% CI 0.442-1.338) and MACCE (0.998, 95% CI 0. 754 -1. 322) , there was hardly any significantly difference in cardiac mortality between three groups (P=0. 223). Conclusion There were more risk factors in heart failure patients with coronary heart disease complicated with obesity or overweight, but the prognosis after revascularization of them is at least no worse than the normal weight coronary heart disease patients.

Objective To report a series of patients with isolated congenital anosmia and summarize their clinical and magnetic resonance imaging ( MRI) characteristics. Methods Twenty patients with isolated congenital anosmia were reviewed retrospectively. A thorough medical and chemosensory history, physical examination, nasal endoscopy, T&T olfactory testing, olfactory event-related potentials, sinonasal computed tomography scan and magnetic resonance image of olfactory pathway were performed in all patients. Results Neither ENT physical examination nor nasal endoscopy was remarkable. Subjective olfactory testing indicated all of them were of anosmia. No olfactory event-related potentials to maximal stimulus were obtained. Computed tomography scan was normal. MRI revealed the absence of olfactory bulbs and tracts in all cases. And hypoplasia or aplasia of olfactory sulcus was found in all cases. All the patients had normal sex hormone level. Conclusion The diagnosis of isolated congenital anosmia is established on chief complaints, physical examination, olfactory testing and olfactory imaging. MRI of olfactory pathway is indispensable.

Objective To evaluate the efficacy of da Vinci surgical system in the treatment of biliary diseases. Methods The clinical data of 15 patients with biliary diseases who had undergone operations with da Vinci surgical system from March 2009 to November 2009 at our hospital were retrospectively analyzed.Results The operations were successfully performed on all patients. And no case was converted into open laparotomy. The total operative duration was 256 151 min and the robot operative duration 224±94 min. No blood transfusion was needed. Postoperative recovery time of bowl movement was 30±18 hours. And the average postoperative hospital stay was 6±3 days. Two patients had postoperative complications and were cured by conservative treatment. Conclusion Various laparoscopic operations for biliary diseases may be performed with the aid of three-dimensional imaging system and flexible surgical tools of the Da Vinci surgical system. And its superiority is more obvious for complicated biliary diseases.

Objective To explore the distribution of Toll-like receptors gene polymorphisms in inflammatory bowel disease (IBD) in Chinese Han patients and Caucasians. Methods The toll-like receptor 2 (TLR2) genes Arg677Trp and Arg753Glu, TLR4 genes Asp299Gly and Thr399Ile, and TLR9 gene 1237T/C polymorphisms were genotypes in 113 patients with IBD and 120 age and gender-matched healthy controls by the analyses of polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).A meta-analysis was performed to test whether TLR4 Asp299Gly and Thr399Ile polymorphisms were associated with ulcerative colitis (UC) or Crohn's disease (CD) susceptibility and whether 299Gly carriage was associated with phenotypes of CD patients in the Caucasian population. Results We found two carriers of TLR9 1237C in UC patients, one carrier in CD patients and one in healthy controls respectively(CD:P=0. 361;UC:P=0. 569) . There was no statistically significant difference in both allelic and genotypic frequencies. The mutant genotypes of TLR2 gene Arg677Trp and Arg753Glu, TLR4 gene Asp299Gly and Thr399Ile were not found in either the IBD patients or the healthy controls. The TLR4 299G allele showed a significant association with CD and UC in Caucasian population (OR=1. 29,95% CI:1. 08-1. 54,P=0. 004 and OR=1. 28, 95% CI:1. 08-1. 51, P=0. 004 respectively) . Similar association was detected between T399I polymorphism and susceptibility to IBD (OR=1.37,95% CI:1. 12-1. 68, P=0. 002 and OR=1. 46, 95% CI:1. 13-1. 88,P=0. 003 respectively). However, no significant association was identified between CD phenotypes and 299Gly carriage. Conclusion TLR2 genes Arg677Trp and Arg753Glu,TLR4 genes Asp299Gly and Thr399Ile and TLR9 gene 1237T/C polymorphisms are not associated with IBD in Chinese Han patients.In Caucasians.both TLR4 299G and 399I confer a significant risk for developing CD and UC.The contribution of genetic determinants may differ significantly between ethnicities.

Objective To evaluate the indications, techniques, outcomes and complications of metallic stent removals in patients with airway disorders. Methods A retrospective analysis was performed in 43 patients with 47 tracheobronchial stents. The airway stent retrieval was performed under the guidance of rigid or flexible bronchoscopy between November 2005 and November 2009. There were 25 cases with 27 Z-type stents (25 covered metallic stents, CMS; 2 uncovered metallic stents, UCMS) and 18 cases with 20 Nitinol stents (4 CMS, 16 UCMS). Excessive stent-related granuloma formation or recurrent tumor in patients with UCMS group was similar to those with CMS (94. 4% vs 89. 7% ). Fracture of stents in patients with UCMS group was higher than that in CMS group (83. 3% vs 10. 3% , P<0. 01). Results Thirty-eight of 47 (80. 9%) stents (Z-type stents 85. 2% , Nitinol 75. 0% ) were successfully removed. Among them, 15 stents (39.5%) were retrieved by rigid bronchoscopy and 23 (60.5%) stents by flexible bronchoscopy (20 under local anesthesia and 3 under pain-free anesthesia). 87. 0% (20/23) Z-type CMS was removed with a retrieval hook by a flexible bronchoscopy under local anesthesia with an average duration of pre-removal stenting of (3.5±0.6) months while 80% (12/15) Nitinol UCMS removed by a rigid bronchoscopy under general anesthesia with an average duration of pre-removal stenting of (10. 7 ±3. 7) months. A successful retrieval of intact stents was achieved in 84. 0% (21/25) of CMS while 92. 3% (12/ 13)of UCMS had a retrieval of rupture stent or piecemeal. In all cases, major post-removal complications included profuse hemorrhage (n=4) and mucosal tear (n=15) . No mortality occurred during theprocedure.Conclusions The indications for endoscopic retrieval of metallic stents include excessive or recurrent granuloma formation or tumor.recurrence of stenosis after stenfing.stent fracture and conclusion of treatment.3-4 months post-stenting in patients with benign stenoses.CMS can be effectively and safely removed with a retrieval hook by flexible bronchoscopy under local anesthesia without any major sequel UCMS may be successfully retrieved by rigid bronchoscopy under general anesthesia.

Objective To evaluate the feasibility and clinical efficacy of a scrotal skin flap in combination with penile lengthening for repairing penile defects. Methods From 1999 to 2008, 7 cases (19 to 42 years old) of penile defects were treated by scrotal skin flap in combination with penile lengthening. The average preoperative length of stubbed penis was 2. 1 cm in flaccid (range:1. 0 to 3. 0cm) and 4. 8 cm in erection (range:3. 0 to 5. 5 cm). All cases were treated with penile elongation. And a bilateral scrotal skin flap supplied by anterior scrotal artery (n =3) or whole anterior scrotum flap (n =4) was used to cover the exposed penile shaft. The scrotal incision was sutured directly. Results There was no need for urethra reconstruction. It was simple to obtain the scrotal akin flap. And the operation might be quickly performed with a lesser hemorrhage as compared with penile reconstruction. The scrotal flaps survived without any necrosis and all wounds healed primarily with an excellent contour and erectile function. When followed up for 1-5 years, the average preoperative penile length was 6. 4 cm in flaccid ( range: 5. 0 to 7. 5 cm) and 9.5 cm in erection (range: 8.0 to 10.5 cm). All cases had normal functions of urination, erection and gonobolia. Five cases had satisfied sexual life and one experienced a sexual life. Conclusions The method of restoring partial penile defect with scrotal skin flaps is both simple and efficacious. Reasonable appearance and penile length are restored in most cases with better sensory and erectile functions.

Objective To investigate the expression of FOXA1 in breast invasive ductal carcinomas, observe its expression in all molecular subtypes of breast invasive ductal carcinomas and understand its diagnostic and prognostic significance. Methods Tissue specimens were obtained from 213 cases of breast invasive ductal carcinoma (IDC) and their expressions of FOXA1 and Ki67 detected by immunohistochemistry. And the expressions of CK5/6 and CK14 were detected to distinguish between normal breast-like subtype and basal-like subtype. Results The expression of FOXA1 was observed in 150 cases (70. 4%). It correlated positively with ER and PR. But there was a negative correlation with histological grade, Nottingham prognostic index, p53 and Ki67. The expression of FOXA1 had difference between luminal and non-luminal subtypes. In luminal subtype, the expression of FOXA1 was associated with histological grade, PR, NPI, Ki67 and A subtype. In terms of prognosis, the expression of FOXA1 predicted a long disease-free survival and overall survival. Conclusion The expression of FOXA1 is associated with a good prognosis. FOXA1 is a promising candidate for clinical identification of luminal A subtype. Prognostic analysis of FOXA1 in low-risk breast cancers may prove to be useful in clinical treatment decision-making.

Objective To investigate the expression level of BRCA1, progesterone receptor A (PRA) and B (PRB) in tissue of sporadic invasive ductal breast carcinoma and further statistically analyze the BRCA1 effects on the expression rates of PRA and PRB. Methods Sixty-eight cases of adenosis of breast and sporadic invasive ductal breast carcinoma were selected The corresponding paraffin-embodied tissues were collected from the archive of Department of Pathology, Nanfang Hospital. The expressions level of BRCA1, PRA and PRB were detected by immunohistochemistry. Wilcoxon two-sample test was used to analyze the differential expression of BRCA1 between adenosis and sporadic invasive ductal breast carcinoma. Chi-square test was used to analyze the effects of BRCA1 on the PRA or PRB expression rate. P value<0.05 was considered statistically significant Results (1) In invasive sporadic ductal breast carcinoma, the positive rate of BRCA1 expression of 60. 29% (41/68) was lower than the positive rate of BRCA1 expression at 85.30% (58/68) in adenosis of breast And the difference of BRCA1 expression between two groups was statistically significant (P< 0.01); (2) In invasive sporadic ductal breast carcinoma, the positive rate of PRA expression for negative BRCA1 expression samples was 81.48% (22/27) and it was higher than the positive rate of PRA expression at 53. 66% (22/47) for positive BRCA1 expression samples. And the difference of PRA expression rates between two groups was statistically significant (P<0. 05).It indicated that the expression of BRCA1 affected the expression rate of PRA; Ininvasive sporadic ductal breast carcinoma.the PRB expression rates between positive and negative BRCA1 expression samples were not statistically significant(P>0.05).It indicated that BRCA1 had no effect upon the expression rate of PRB.Conclusion In sporadic breast carcinoma.a negative expression of BRCA1 is selectively associated with a higher expression rate of PRA rather than PRB.Thus BRCA1 selectively regulates the expression of PRA in sporadic breast carcinoma.

Objective To study the effect of interleukin 17 (IL-17) with mechanism of pulmonary inflammatory in smokers with normal lung junction and chronic obstructive pulmonary disease ( COPD) patients. Methods The peripheral lung cancer patients in need of a surgical therapy were divided into normal lung function and non-smoking group (NS group,n=10), normal lung function and smoking group (S group,n=13) and smoking with stable COPD group (COPD group,n=10). The fresh normal lung tissue was harvested from the surgical specimens with a margin of 5 cm away from resection foci. Then the lung tissue levels of IL-17 were detected with enzyme-linked immunosorbent assay. The average alveolar area, the total small airway pathology score and the pulmonary muscular artery (MA) wall thickness were measured by HE and Victoria blue-Van Gieson's stains. The IL-17+cells and CD4+, CD8+lymphocytes in alveolar walls, small airways and lung MA were analyzed by immunohistochemistry. The investigators also explored the relationships between IL-17 level, pathological morphology of pulmonary parenchyma, small airway, pulmonary artery reconstruction and pulmonary functions. Results The IL-17 levels in lung tissue of NS, S and COPD groups were 6. 1 (3.7-12.4), 9.7 (3.5-69.7) and 22.7 (7.0-114.4) pg/mg respectively. The S and COPD groups were significantly higher than the NS group (P < 0. 05, P < 0.01). The S group was significantly higher than the NS group (P<0. 05 ) . The average alveolar area were (50 708 ± 14 125), (106 517 ± 13 851) and (152 344 ± 43 783 )μm2 , the total small airway pathology score (49 ± 10) , (101 ±34) and (163 ±36), and the MA wall thickness (119 ± 11), (139 ± 25) and (172 ± 28) μm respectively. The S and COPD groups were significantly higher than the NS group ( P < 0. 05, P < 0. 01). And the COPD group was significantly higher than the S group (P < 0. 05, P < 0. 01). IL-17 was predominantly expressed in lung infiltration of inflammatory cells. IL-17 of alveolar walls, small airway wall and MA wall in the S and COPD groups were significantly higher than the NS group. And the COPD group was significantly higher than NS group (P < 0. 05). IL-17 + cells were positively correlated with the average alveolar area in pulmonary parenchyma (r = 0. 561, P < 0. 01), the pulmonary artery wall thickness in M A ( r =0. 682, P < 0. 01) and the pathological score in small airways (r =0. 425, P < 0. 05). IL-17 + cells of pulmonary parenchyma, small airways and MA were positively correlated with CD4 + and CD8 + lymphocytes in lung (P < 0. 05, P < 0.01). The levels of IL-17 in lung homogenate tissue showed a negative correlation with the FEV1 percentage of predicted value ( r = - 0. 471, P < 0. 01). Conclusions IL-17 is up-regulated in lung tissues of normal lung function smokers and COPD patients. And it has a close correlation with CD4 + and CD8 + lymphocytes in lung, lung parenchyma destruction, pulmonary inflammation, pulmonary artery reconstruction and airflow limitation. All of these suggest that IL-17 plays an important pro-inflammatory role in COPD.

Objective To estimate the potential effects of hBMP-7 gene transfected bone manow stromal cells (BMSC) and to provide a new way for repairing the periodontal defects. Methods A total of 30 experimental class Ⅱ furcation defects in five Beagle dogs were created surgically. The transfected and non-transfected BMSC were seeded in collagen membrane at an initial concentration of 1×107/ml and transplanted into experimental class Ⅱ furcation defects. The animals were sacrificed at 12 weeks post-operation and periodontal regeneration was evaluated by the histological and morphometric analysis. Results In both experimental and control groups, there were different extents of regeneration. The percentage of new alveolar area in transfected and non-transfected BMSC were significantly higher than the control(P<0. 05). And there was also significant difference between two experimental groups (P<0. 05). The percentage of new cementum length in two experimental groups were significantly higher than the control(P<0. 05). But there was no significant difference between two BMSCs groups (P>0. 05) . Conclusion hBMP-7 gene enhanced tissue enginccring could be a betler way to repair the perlodntal defeits.

Heart failure (HF) is a pathophysiological syndrome caused by various pathological stimuli, and the mortality rate is as high as 50%. The research on its pathogenesis has reached the level of molecular biology, and it has been confirmed that the expression of heart changes significantly in HF, and microRNA (referred to as miRNA) is involved in the regulation as an important gene expression factor.

The United States and Europe published guidelines on pulmonary hypertension (PH) in March and August 2009. The former was co-authored by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA)<ACCF/AHA Expert Consensus on Pulmonary Hypertension>[1], which was authored by the European Cardiology Association (ESC) and the European Respiratory Association (ERC) and accredited by the International Heart and Lung Transplant Association<Guidelines for the diagnosis and treatment of pulmonary hypertension>[2]. They are the latest guidelines in the field of PH, and each has its own characteristics, but some aspects are controversial.