Pulmonary arterial hypertension (PAH) is an incurable fatal disease, with the mechanism of imbalance of vascular contraction and relaxation which start as a series of pathophysiological reactions. Angiotensin-converting enzyme 2-angiotensin (1-7)-G protein-coupled receptor axis [ACE2-Ang(1-7)-Mas], an expanded vascular axis which is considered as new axis of renin-angiotensin system (RAS) is a negative regulator of the classical angiotensin-converting enzyme-angiotensin Ⅱ-angiotensin Ⅱ type 1 receptor axis (ACE-AngⅡ-AT1R), a contraction vessel, proliferation axis. A retrospective study concerning the pathophysiological mechanism of ACE2 in the treatment of PAH was done and found that ACE2-Ang-(1-7)-Mas axis could reduce PAH induced by monocrotaline (MCT) through declining the inflammatory cascade, improving endothelial dysfunction and regulating autonomic nerve, reduce PAH induced by hypoxia through inhibiting the proliferation of pulmonary artery smooth muscle cells and reduce PAH induced by congenital heart disease. Therefore, ACE2 may become a future drug of preventing and treating PAH.

Objective To investigate the effect of recruitment maneuver (RM) on acute respiratory distress syndrome (ARDS).Methods A total of 7 patients with early ARDS were involved in this investigate with pressure-control ventilation of FiO2 =1.Hemodynamics and extravascular lung water index (EVLWI) were monitored.After airway preparation,the ventilation parameters were adjusted to inspiration pressure (Pi) =24 cm H2O,positive end-expiratory pressure (PEEP) =10 cm H2O,frequency (f) =50,inspiration/expiration (I/E) =5/1.Up regulated PEEP to 24 cm H2O and Pi to 45 cm H2O for 3 respiration cycles.Then down regulated Pi to 30 cm H2O and had the artery blood gas analysis immediately.If PaO2 ＜ 450 mm Hg,Pi was increased 5 cm H2O above the last one,until PaO2 ＞ 450 mm Hg,which was considered RM success.Then PEEP was decreased 2 cm H2O and repeated the cycle as formers until PaO2 ＜350 mm Hg.The optimal PEEP was 2cm H2O above that.Maintained this airway pressure at least for 4 hours.Artery blood gas and hemodynamics of pre-and post-RM were monitored.The RM would be stopped by any unstable hemodynamic.Results In 6 of 7 patients,PaO2 and PEEP were higher than the baseline (P ＜ 0.01) after 4 hours of RM ; EVLWI decreased (P ＜ 0.01).RM was stopped in 1 patient,because of the unstable hemodynamic.None of the 7 patients got RM complications ; meanwhile,6 patients were cured.Conclusions Applying RM on ARDS is safe and effective.

To determine the effects of Von Hippel-Lindau (VHL) on the invasion and migration of glioma U251 cells. Methods:U251 GBM cells were transfected using VHL expression plasmid. Real-time polymerase chain reaction was conducted to de-tect VHL mRNA expression after transfection. Western blot assay was used to measure protein (VHL, MMP-2, and MMP-9) expres-sion. Tumor invasion and migration were examined by the Transwell and wound-healing experimental methods after VHL up-regula-tion. The intracranial model of nude mouse was developed using U251 cells transfected by VHL expression plasmid, and immunohisto-chemical staining was used to measure protein (VHL, MMP-2, and MMP-9) expression in the tissue sections. Results: In the U251 cells transfected by VHL expression plasmid, the expression of VHL mRNA and VHL proteins increased, and the expression of MMP-2 and MMP-9 protein decreased. Meanwhile, the invasion and migration of glioma U251 cells were also inhibited. Immunohistochemical staining results showed that the expression of MMP-2 and MMP-9 proteins decreased, and the VHL protein expression increased after transfection. Conclusion:VHL can inhibit the invasion and migration of glioma U251 cells. Thus, VHL gene can be used as a target for the gene therapy of gliomas.

Objective To compase laparoscopic vs open appendectomy in the treatment of appendicitis.Methods The clinical data of 1 716 appendicitis patients are studied in the form of retrospective summary,who were hospitalized in Jilin University China-Japan Union Hospital from 2009 to 2014.Patients were divided into laparoscopic appendectomy group and open appendectomy group.Duration of operation,surgical complications and postoperative recovery were evaluated.The chi-test and the student t test were used for statistics.Results More patients in open group with chronic lung disease,or a history of previous abdominal surgery than in the laparoscopic group (x2 =3.527,22.804,P ＜ 0.05);the postoperative deep vein thrombosis,intestinal obstruction,abdominal abscess and infection of incision in open group were more often seen than in laparoscopic group (x2 =4.179,4.71,7.351,8.766,P ＜ 0.05);Open group scored higher than laparoscopic group on the index of 24 hours of postoperative pain (t =-3.163,P =0.004);duration of surgery was similar (t =1.754,P =0.092 2);the laparoscopic group was better in recovery time of postoperative intestinal peristalsis,average length of scar and the average hospital stay (t =3.460,-15.335,-3.629,P ＜ 0.05).While the average hospitalization cost in open group is less than in the laparoscopic group (t =5.763,P =0.001).Conclusions Both laparoscopic appendectomy and open appendectomy were effective for the treatment of appendicitis,while laparoscopic appendectomy is superior to open procedure in reducing postoperative pain,postoperative complications promoting rapid recovery,shortening hospital stay and more cosmetic.

Objective To evaluate the intraoperative advantage and short-term outcomes of three-dimensional laparoscopic surgery for rectal cancer.Methods The clinical data of patients who underwent radical resection for rectal cancer at Department of Colorectal Surgery,China-Japan Union Hospital of Jilin University from November 2013 to February 2014 were retrospectively analyzed.There were 20 patients undergoing three-dimensional laparoscopic surgery and 26 patients undergoing two-dimensional laparoscopic surgery.The following parameters were compared between the two groups:intraoperative factors,oncologic outcomes,and short-term surgical outcomes.Data were analyzed by SPSS 17.0 software packet,using t and x2 inspection.Results All the operations were perfomed successfully without conversion.Compared with the two-dimensional laparoscopic surgery group,the three-dimensional laparoscopic surgery group had shorter operative time [(97.2 ± 19.3) vs.(114.1 ± 22.6) min,t =2.680,P =0.010],less intraoperative blood loss [(13.5 ± 6.7) vs.(20.1 ± 12.7) ml,t =2.288,P =0.028],less stapler docking times [(1.4 ± 0.6) vs.(2.3 ± 0.8) number of times,t =4.962,P =0.000],earlier removal of urethral catheter [(2.2± 0.6) vs.(2.7 ± 0.8) d,t =2.401,P =0.021].There were no significant differences in the postoperative ventilation time,postoperative hospital stay,number of lymph node dissection (all P ＞ 0.05).Conclusions Three-dimensional laparoscopic compared with two-dimensional laparoscopic radical resection for rectal cancer has many advantages,such as shorter operative time,less intraopretive blood loss,high accuracy operation and earlier postoperative urine voiding.

Objective To investigate the hallux nail flap with the tibia lateral diamond shaped flap of the second phalange,joints,tendon combined tissue combination reengineering the surgical methods and clinical effects of thumb.Methods From May,2010 to February,2015,thcrc had fifteen cases of the thumb defect on Ⅱ-Ⅳ degree of the patients in our hospital,and we took anastomosis vascular pedicle of the hallux nail flap and thumb reconstruction with a second phalange with the tibia lateral diamond shaped flap,joint,and tendon composite tissue combination to reconstruct the thumb.The provided district of the second metatarsal was amputated to repair the ligaments between metatarsal bones.And we took the second toe bone nail flap covering the hallux toe area wound in anterograde shift.Results 15 cases of thumb reconstruction survived.The patients were followed-up for 6 to 30 months,the shape of the reconstructed thumb was closed to the contralateral thumb.The thumb to the finger and the palm function was good,two-point discrimination of the finger pulp were 0.6-1.0 cm.According to the upper limb function of the Chinese Medical Association Hand Surgery Society,the upper limb partial function of the evaluation trial standard:excellent in 11 cases,good in 4 cases.The district was recovered well,normal walking and running function were not restricted.Long term follow-up showed no blisters formation and skin ulceration.No nail deformity,good growth.Conclusion The hallux nail flap with the tibia lateral diamond shaped flap of the second phalange,joints,tendon combined tissue combination to reconstruct the thumb of the defect on Ⅱ-Ⅳ degree can restore good function and feeling,but also to have beautiful appearance.It is an effective method for reconstruction of thumb defect on Ⅱ-Ⅳ degree.

Objective To assess the risk factors of the in-hospital mortality of acute type A aortic dissection after operation. Method From January 2003 to June 2008,185 patients, 144 males and 41 females, with acute type A aortic dissection operated on were enrolled. The average age of patients was (49.46 ± 11.04 ) years old.The patients' demographics, history, clinical features, and some laboratory examinations were reviewed. Univariate and multivariate analysis followed by logistic regression analysis were carried out to identify the predictors of inhospital mortality. Results The in-hospital mortality rate was 9.1%. The results of univariate and multivariate analyses as follows: pre-operation positive neurological symptom (Univariate OR = 5.084,95%CI:1.792 -14.426, P = 0.002; Multivariate OR = 5.538,95%CI: 1.834 - 16.721, P = 0.002, respectively), hypotension (Univariate OR = 6.986,95%CI:1.510- 32.323,P =0.013; multivariate OR = 1.998,95%CI:0.315-12.679,P = 0.463, respectively) and renal failure (Univariate OR = 3.594,95%CI:1.237 - 10.438,P =0.019; Multivariate OR = 3.254,95%CI:1.034- 10.242, P= 0.044, respectively). Conclusions There are two predictors, pre-operation positive neurological symptom and renal failure, of pre-hospital mortality found in current analyses. Our results may improve the regimen made by cardiac surgeons and emergency doctors so as to help patients and their relatives to make correct decision.

Objective To evaluate the clinical safety, efficacy and long-term outcome of transcatheter occlusion for ruptured aortic sinus of valsalva aneurysm (RASA) into the right atrium.Methods Between January 2006 and April 2013, fifteen patients [11 males and 4 females,aged from 21 to 48 years with an mean age of (35.50±8.79) years] with RASA ruptured into the right atrium were enrolled in this study.Domestic made patent ductus arteriosus (applied in six patients) or small waist double-disk ventricular septal defect (applied in nine patients) occluders were used for transcatheter closure.All the patients were followed up for any change in cardiac rhythm,and residual shunt,occluders morphology and possible valve regurgitation by echocardiography.Results All RASA were confirmed by aortography,including eleven cases with rupture of right coronary sinus of valsalva and four cases with rupture of the noncoronary sinus of valsalva shunting into the right atrium.NYHA function class was(2.56±0.63)before the occlusion.Cardiac catheterization showed mean pulmonary arterial pressure and Qp/Qs ratio were (25.38±8.21)mmHg (1 mmHg=0.133 kPa) and 1.34-2.81(1.93±0.39), respectively.Aortic angiography showed that the RSA was 4-10(6.42±1.92)mm at its narrowest end.There was no serious complication during the operation and all the patients had successful transcatheter closure without residual shunt.After transcatheter RASA occlusion, mean pulmonary artery pressure decreased to (16.1±5.3) mmHg (P<0.05).The diameter of right atrium,right ventricle, left atrium and pulmonary artery diameter and left ventricular end-diastolic dimension all showed significant decrease (P<0.01).All patients were followed up for 35-132(78.6±28.57)months.All patients presented with a NYHA function class Ⅰ to Ⅱ cardiac function in their last follow up which was significantly improved compare to pre-occlusion level (P<0.01).There were no infective endocarditis,device displacement and embolism,serious aortic regurgitation,myocardial ischemia,serious arrhythmia or death in any of the patients during follow up.Conclusions Transcatheter closure of Valsalva aneurysm ruptured into right atrium with the domestic made patient ductus arteriosus and small-waist ventricular septal defect occluder is safe and effective with a good long term prognosis.

Digestive tract is one of the biggest contact surfaces between human body and environmental factors. It has a large number of microorganisms from the environment. Once bacteria transfer and release into the blood, it will cause sepsis and endanger life. Therefore, we should pay more attention to the infectious diseases of digestive system. This paper reviews six articles published in this journal, and expounds the etiology and early recognition methods of severity of three common infectious diseases of acute digestive system, namely, acute diarrhea, acute cholangitis and acute pancreatitis, and puts forward potential targets for the treatment of sepsis from the perspective of neurohumoral and integrated traditional Chinese and western medicine. Therefore, we should pay attention to the early recognition of the severity of infectious diseases of digestive system and the treatment of integrated traditional Chinese and western medicine.

Objective To observe the myocardial apoptosis and the molecular mechanism of captopril inhibiting myocardial apoptosis on cardiac arrest (CA) after resuscitation in a porcine acute pulmonary embolism (APE) model. Methods In this study, 29 inbred Beijing Landrace wererandomly (random number)divided into four groups (n=5, each group): control, APE-CA, restoration of spontaneous circulation (ROSC)-captopril, and ROSC-saline. The model of CA and ROSC was induced by APE through injection of thrombus followed by cardiopulmonary resuscitation and thrombolytic therapy (urokinase, 15000 U/kg, iv). Ten of 19 pigs with CA recovered to spontaneous circulation were divided randomly into the ROSC-captopril and ROSC-saline groups. Pigs in the ROSC-captopril group were treated with captopril (22.22 mg/kg) via porcine femoral vein at 30 min after ROSC. Pigs in the ROSC-saline group were treated with equal normal saline at 30 min after ROSC. The myocardial tissues were evaluated at 6 h after ROSC. Western blot was used to evaluate the protein levels of Bax, Bcl-2, Caspase-3, phosphorylated (p)-Src and phosphorylated extracellular regulated protein kinase (p-ERK1/2). Immunohistochemistry was used to evaluate the protein expression of p-Src and p-ERK1/2. Enzyme-linked immunosorbent assay was used to detect myocardial Na+-K+-ATPase levels. Statistical analysis was performed using one-way analysis of variance and pearson correlation test. Results Compared with the control group, the protein expression of Bax (0.25±0.01, 0.53±0.01, 0.37±0.05, F=14.16, P<0.05) and Caspase-3 (0.24±0.01, 0.33±0.01, 0.34±0.06, F=7.32, P<0.05) in the APE-CA and ROSC- saline group were increased significantly, and the Bcl-2 expression was significantly decreased (0.56±0.02, 0.19±0.01, 0.37±0.10, F=6.68, P<0.05). Captopril reduced the protein levels of Caspase-3 and Bax, while stimulated the Bcl-2 expression (all P<0.05). Compared with the control group, the protein expression of p-Src and p-ERK1/2 were higher and the Na+-K+-ATPase level was decreased on CA and ROSC induced by APE (all P<0.05). Compared with the APE-CA group, the p-Src expression in the ROSC-captopril group (0.46±0.01 vs. 0.35±0.06, P<0.05) was decreased significantly. Captopril inhibited the activation of p-ERK1/2 than saline group (0.41±0.10 vs. 0.26±0.07, P<0.05), but has no effect on the Na+-K+-ATPase level. The protein expression of p-Src and p-ERK1/2 were positively correlated with the Bax, and negatively correlated with the Bcl-2 respectively. The myocardial Na+-K+-ATPase level negatively correlated with Caspase-3 protein expression. Conclusions The molecular mechanism of cardiomyocyte apoptosis on CA and ROSC induced by APE might be related to decreased Na+-K+-ATPase level and activation of p-Src and p-ERK1/2. The cardiomyocyte apoptosis were inhibited by captopril through reducing the expression of p-Src and p-ERK1/2 in myocardium.