Oxidative stress and inflammation are two main factors in the progress of diabetic nephropathy(DN) and its complications. NF‐E2 p45‐related factor (Nrf2) is a crucial transcriptional factor which manipulates downstream genes that encode some antioxidant enzymes and phase Ⅱ detoxifying enzymes ,to maintain the redox homeostasis and cellular detoxification response. Therefore ,more and more researchers are focusing on the role of Nrf2 in DN. In this review ,the detailed role of Nrf2 in DN will be discussed. Hopefully ,our work can epitomize recent research progress and provide novel clues for diabetic nephropathy prevention and treatment.

Objective To investigate the predictive value of epicardial adipose tissue(EAT) thickness for the recurrence of atrial fibrillation (RAF) after concomitant valve replacement and bipolar radiofrequency ablation.Methods From January 2012 to May 2014,156 patients with permanent atrial fibrillation and organic valvular diseases underwent concomitant valve replacement and successful bipolar radiofrequency ablation in the First People's Hospital of Shangqiu.After 1 year of follow-up,the recurrence of AF was analyzed and the correlation factors were analyzed statistically.Results All patients completed a regular follow-up.During a 12-month follow-up period,RAF was observed in 39 patients (25.0％).Echocardiography-derived regional EAT thickness was significantly greater in RAF patients than that in non-RAF patients((6.9±0.6) mm vs.(5.5±0.7) mm,t=4.649,P＜0.05).The EAT thickness strongly correlated with patients age,body mass index,Ratio of left atrial diameter,mitral diastolic blood flow velocity and early diastolic velocity of mitral annulus,low density lipoprotein-cholesterol and thyroglobulin (r =0.62,0.57,0.68,0.59,0.73,0.76;P ＜ 0.05).Cox multivariable analysis showed that,duration of AF history (95％CI:1.01-1.15,P =0.040),left atrial diameter (95％CI:1.07-1.24,P =0.021) and EAT thickness (95％CI:1.05-1.79,P =0.009) were independent predictors of RAF.Conclusion Echocardiography-derived regional EAT thickness combined with left atrial diameter may serve as effective parameters in identifying patients at the highest risk for RAF.

Objective To review the outcome of coronary artery bypass graft (CABG) using left internal thoracic artery grafts in the patients aged over 70 years old.Methods Two hundred and eighty-eight patients aged over 70 years old from January 2009 to January 2014 who underwent CABG were selected.All of the patients were divided into two groups on base of the graft:control group:only saphenous vein graft was used in 138 cases; observation group:the left internal thoracic artery to the left anterior descending artery was used in 150 cases,which also included total arterial grafting,facilitated by the use of the radial artery,right gastroepiploic artery was operated in 7 cases,beside these artery grafts,saphenous vein graft was used to anastomosis with other vessels.Results Operative mortality was 2.9％ (4/138) in control group and 2.0％ (3/150) in observation group,and there was no significance (P ＞ 0.05).The volume of blood drainage was larger in observation group [(796.2 ± 382.4) ml] than that in control group [(512.8 ± 387.5) ml],and there was significant difference (P ＜ 0.05).At the same time,there was no significant difference in the incidence rate of second thoractomy,malignant arrhythmia,stroke,poor wound healing,and usage of intraaortic balloon counterpulsation between two groups (P ＞ 0.05).Conclusion It does not increase the mortality and incidence of serious complications using the left internal thoracic artery to the left anterior descending artery in the patients aged over 70 years old during CABG.

There are some major changes win the revised 2016 WHO Classification of Lymphoid Neoplasms.Based on the clinicopathological changes and genetic/molecular findings in the past years,the new classification clarified the diagnosis and clinical management of some very early stages of lymphoproliferative disorders,refined the diagnostic criteria for some lymphoid neoplasms,and further emphasized the significance of genetic/molecular studies in the diagnosis and clinical treatment of lymphomas.A small number of new provisional entities were added to the 2016 edition.

Tumor vaccine is one of the most promising therapeutic strategies in tumor immunotherapy. It promotes the antigen presentation process by delivering tumor antigen and then activates the anti-tumor immune response. As a new class of vaccines, messenger RNA (mRNA) vaccines can activate the immune system to achieve the purpose of immunotherapy by delivering the mRNA sequence of a specific antigen into the body and expressing the corresponding antigen protein. Compared with traditional vaccines, mRNA vaccines have the advantages of a short production cycle, high effectiveness, and strong immunogenicity. In recent years, the application of mRNA vaccines in tumor immunotherapy has attracted widespread attention, but the instability and low delivery efficiency of mRNA limit its application. Nano delivery system can effectively solve the problem of mRNA vaccine delivery, greatly promote the research process and clinical application of mRNA tumor vaccines, and has become a hot spot in the research of mRNA vaccines. In this review, we introduced the mRNA tumor vaccines, focusing on the application of nano delivery system in mRNA tumor vaccines, in order to provide new ideas and new methods for the efficient delivery of mRNA tumor vaccines and tumor immunotherapy.

[Objective] To guide the clinical application of Fuyang medicine through the study of San Jiao Theory of ZHENG Qin'an [Method] To study the foundation theory of ZHENG Qin'an and correlate the evidence with the concept of original yang, San Jiao, Emporer fire, Minister fire and middle earth. To explain the unity and inter-relation of San Jiao and the symptons of yang deficiency of San Jiao and the approach of the use of medicine with the support of case studies. [Result] Zheng Qin'an suggested that three Jiaos are of one Jiao. The yang of upper jiao is governed by Emperor fire while that of lower Jiao by Minister fire. The two fires are of one fire. The circulation of the two fires generates the middle earth. When the middle yang fails on circulating the upper and lower Jiaos cannot communicate. The root of original yang is the kidney which is nourished by the spleen. The unity of San Jiao, the use of lower yang as the root of upper and middle yang and the use of the circulation and root nourishing action of middle yang are the keys to application of medicine. [Conclusion] The use of medicine of ZHENG strongly adhered to the qi circulation of San Jiao. It showed to the later generations a simple but comprehensive thought of Chinese medicine. It was an important guidance for the use of Fuyang medicine.

Objective To summarize the management experience for difficult access during rigid transurethral ureteroscopy.Methods Rigid transurethral ureteroscopy was conducted in 640 patients with ureteral stones from January 1995 to November 2004.Difficult ureteroscope access was encountered in 72 patients and overcame by adjusting the pressure of hydraulic irrigation,changing the position of patient,dilating the ureter,or performing the percutaneous nephrostomy.Results Of the 72 patients with difficult retrograde access,successful ureteroscopy was achieved in 54 patients and conversions to open ureterolithotomy were required in 18 patients.Intraoperative complications included partial mucosal laceration in 10 patients and ureteral perforation in 6 patients.Follow-up examinations with intravenous pyelography for 13~36 months(mean,16 months) in 56 patients revealed patent ureter.Conclusions The key to successful retrograde access of rigid ureteroscope lies in the acquaintance with normal and pathologic anatomy and physiology of the ureter and urologist's operative skills and experience.

Objective:To analyze imaging diagnosis and differential diagnosis of upper femur aneurysmal bone cyst.Methods: The pre-operation imaging appearances about digital radiography(DR), computerized tomography (CT) and magnetic resonance imaging (MRI) of 46 aneurysmal bone cyst cases confirmed by operation and pathology were retrospectively analyzed, and then these special imaging appearances were gained and analyzed.Results:①CT plain scans showed the irregular expansile lucency shadow in the upper femur with the uneven bone septum image; the complete or incomplete osteosclerosis edge can be found in some parts of lesions; some lesions extend to adjacent soft tissue, and the liquid-liquid level can be found in lesion of 8 cases, and their edge and separated intensity strengthening were visible after signals were enhanced.②MRI plain scans revealed that most lesions showed long T1, T2 signals, the periphery of lesions showed long T1, short T2 signal shadows, and septum image was visible within lesions, and the liquid-liquid level can be found in lesion of 8 cases; some lesions extend to adjacent soft tissue, and their edge and separated intensity strengthening were visible after signals were enhanced.Conclusion: Through combined examination of DR, CT and MRI, the specialty and diagnostic accuracy of aneurysmal bone cyst could be improved, and it was helpful in the differential diagnosis of other upper femur bone tumors.

This article emphasizes the importance of medical communication and expounds how to strenthen medical communication by some principles and methods,like paying attention to and lov-ing patients,listenning carefully,explaining patiently and confidently,learning modestly and so on.

Objective To investigate the effect of Mlot-4 cells onset with Roscovitine (ROSC)as some Cyclin-dependent kinases(CDK),inhibitor.Methods The logarithmic growth phase Molt-4 cells treated with ROSC at a final concentration ranging between 1～20 μmol/L and harvested in different time point,DNA assay of single cells by flow cytometry was used to detect the effect of cell cycle arrest and Annexin-V/FITC assay was used to detect the effect of cell apoptosis. Results It showed that ROSC exerted strong inhibitory effect on proliferation and cell cycle progression of Molt-4 Accumulation of G2/M arrested cells starting 6 h after onset of 10 μmol/L and 20 μmol/L ROSC;at the same time,the cell apoptosis of Molt-4 would be detected,According with the time and concentration changing,the cell apoptosis rate would rise.Conclusion It is concluded that Roscovitine(ROSC)as some Cyclin-dependent kinases(CDK),inhibitor,It has dual effects to Molt-4 cells,not only the effect of cell cycle arrest but also the effect of cell apoptosis.