Pathologist Dixit in American Michigan University found a gene induced by cytokine from human umbilical vein endothelial cells in 1990.This gene is increased in a variety of cells rapidly and coded a special kind of the zinc finger protein when being stimulated by interleukin-1 (IL-1),PLS and tumor necrosis factor (TNF).The gene was named as zinc finger protein A20 gene,and its coding protein was named as zinc finger protein A20.A20 is a kind of endogenous regulatory protein,inhibiting the inflammatory reaction and cell apoptosis through the inhibition of NF-kappa B activity.This article mainly reviewed the structure,function and clinical significance of A20.

In the light of mathematical maximum likily hood method, the conditioned probability of clinical manifestations in TCM syndrome of asthenic heart qi - and blood and control group were calculated to establish a " List of Quantitative Diagnostic Index of TCM Manifestations Differentiation for Qi and Blood in Heart Disease". Based on the scoring of the above list, the rate of coincidence of retro - spective test of the three signs were 92. 70%, 93. 20%, 94. 98% respectively, and that of prospective test were 84. 61%, 81.82%, 87. 50% respectively. Authors' address: Institute of diagnostics, Hunan College of TCM, Changsha, Hunan 410027

Objective Transesophageal Doppler monitoring ( TDM) has been widely applied to fluid therapy in some major op-erations but rarely used in aortic valve replacement.The purpose of this study was to assess the value of TDM in fluid therapy, vasoactive drugs use, and left ventricular function in patients undergoing aorta valve replacement after cardiopulmonary bypass. Methods This study included 40 patients undergoing aotic valve replacement after cardiopulmonary bypass in Anhui Provincial Hospital from March 2014 to June 2015, which were randomly assigned to a TDM and a control group of equal number.TDM was used for the guidance of fluid infu-sion and vasoactive drug administration for the patients in the former group, while central venous pressure, mean arterial pressure, and heart rate were employed for those in the latter.The fluid volume infused, urine volume, blood loss, hemodynamics, arterial blood lac-tate, and outcomes were compared between the two groups. Results Compared with the control, the TDM group showed significantly increases in the colloidal fluid volume ([303 ±60] vs [373 ±65]mL, P<0.05), crystal fluid volume ([533 ±87] vs [596 ±83]mL, P<0.05), and urine volume ([274 ±95] vs [338 ±84]mL, P<0.05), but remarkable decreases in the red blood cell count, blood plasma vol-ume, postoperative extubation time, doses of dopamine and dobu-tamine, and length of hospital stay (all P<0.05).The hemodynamics were more stable and arterial blood lactate was lower in the TDM group than in the control (P<0.05). Conclusio n Transesophageal Doppler monitoring can timely and exactly manifest the hemodynamic changes and left ventricular function of the patient undergoing aotic valve replacement and provide precise guidance for fluid therapy and vasoactive drug administration.

Objective To explore the relationship of molecular biology characteristic and the treatment outcome,and influence factors of neoadjuvant chemotherapy (NAC) in inflammatory breast cancer (IBC).Methods The clinicopathological data of 103 IBC patients who were treated with NAC from January 2005 to June 2013 were analyzed retrospectively.Immunohistochemical method was used to detect the expression of estrogen receptor (ER),progesteron receptor (PR),human epidermal growth factor receptor 2 (HER-2) and E-cadherin.The treatment outcome were evaluated.Results In 103 IBC patients,ER negative was 48 patients,PR negative was 51 patients,HER-2 positive was 45 patients,E-cadherin positive was 66 patients.The effective rate of chemotherapy was 72.8％ (75/103).The effective rate of chemotherapy in taxane-based group was significantly higher than that in anthracycline-based group [80.6％ (50/62) vs.61.0％(25/41)],and there was significant difference (P ＜ 0.05).The effective rate of chemotherapy in ER,PR,E-cadherin negative patients was significantly higher than that in ER,PR,E-cadherin positive patients [83.3％ (40/48) vs.63.6％ (35/55),82.4％ (42/51) vs.63.5％ (33/52),83.8％ (31/37) vs.66.7％ (44/66)],and there was significant difference (P ＜ 0.05).The effective rate of chemotherapy in taxane-based group with E-cadherin positive patients was significantly higher than that in anthracycline-based group with E-cadherin positive patients [77.5％ (31/40) vs.50.0％ (13/26)] (P ＜0.05).No correlation existed between the expression of HER-2 and the treatment outcome of chemotherapy (P ＞ 0.05).Conclusion ER,PR and E-cadherin negative patients with IBC is chemosensitive to NAC.The positive expression of E-cadherin may be an important factor of chemotherapy resistance.For the patients with E-cadherin positive,taxane-based chemotherapy regimen can achieve a better effective rate.

The medical records of all 12 patients diagnosed as chronic active Epstein-Barr virus (CAEBV) infection at our hospital were analyzed retrospectively.There were 7 males and 5 females with a median onset age of 28 years.CAEBV was characterized by fever,splenomegaly,hepatomegaly and lymphadenopathy,etc.The abnormalities of laboratory examination included liver dysfunction,thrombocytopenia,anemia and leucopenia.EBV-DNA detected by real-time polymerase chain reaction was (1.7 × 103-3.5 × 107) copies/μg DNA in peripheral blood mononuclear cell.Among them,the outcomes were death (n =5),lost to follow-up (n =2) and T cell lymphoma (n =1).It is necessary to improve our awareness of CAEBV infection because of its poor prognosis and high mortality.

Objective To improve the diagnosis and treatment of Q fever endocarditis.Methods From 2008 to 2013,four cases of Q fever endocarditis were diagnosed in Peking Union Medical College Hospital.Clinical features,laboratory test,management and prognosis were analyzed with literature review.Result All four cases had long period of fever and heart murmur.Two patients represented with respiratory symptom and one with non-specific rash.General laboratory tests including complete blood cell count,ESR,C-reactive protein(CRP),liver function and radiology of lung did not show specific abnormalities.Signs of endocarditis were shown by ultrasound and important for diagnosis.Repeated blood culture was negative.All of the diagnoses were confirmed by serum antibody detection and the patients recovered well with treatment based on doxycycline or minocycline.Conclusions Endocarditis is the most common form of chronic Q fever,which is easily misdiagnosed because its blood culture is negative and may accompanied with varied manifestation such as pneumonia and liver injury.For the patients with chronic fever and blood culture negative endocarditis,chronic Q fever should be considered as differential diagnosis.The confirmatory method for diagnosis is serum antibody detection.Early and sufficient treatment may improve the prognosis.

Objective To explore the efficiency of temporary cardiac pacing on the acute poisoning patients with serious bradycardia.Methods Thirty-eight cases of the acute poisoning patients with serious bradycardia were treated randomly with temporary cardiac pacing (pacing group, 18 cases) and drug therapy (control group,20 cases) and followed with treatment for poisoning. Results Right ventricular pacing were successfully performed in 18 cases and the temporary cardiac pacemaker were placed. With the further treatment of poisoning, in the pacing group, the efficiency of anit-bradycardia and the poisoning cure rate was 100% and 88. 9% , respectively, whereas being 60% and 65.0% in the control group, respectively. The efficiency of anit-bradycardia and the poisoning cure rate were significantly different between the two groups (P < 0.01 or P < 0.05 ). Conclusions The treatment of temporary cardiac pacing has effect on the acute poisoning patients with serious bradycardi. It can effectively improve the rate of patients' resuscitation.

Objective To establish the reconstructive ladder for the leg without sufficient recipient vessels by case analysis and literature review.Methods From January,2009 to January,2015,772 cases were treated in our center using free flap for leg coverage and 129 cases were found intra-operatively to have insufficient recipient vessels.There were 113 males and 16 females,and the age ranged from 4 to 71 years,averaging 36.5 years.The wounds were post-traumatic (n=108) and non post-traumatic (n=21).The management methods included elongating incision (n=25),vessel transfer(n=22),Flow-through anastomosis(n=17),end-to-side anastomosis (n=13),useing neighboring vessels (n=1S),anastomosis distal to the injured zone (n=14),cross-leg free flap (n=7),and abandoning free flap transfer(n=13).Results Except for the cases of abandoning surgery (n=13,10.1％),there were 86 cases whose flap healed totally (66.7％),9 cases total lost(7.0％),and 11 cases marginal loss (8.5％).It established a reconstructive ladder for this special situation according to the principle of difficulty level.Conclusion The insufficient recipient vessels of the leg were had multi-causes which should be taken account generally before surgery.The optimal protocol for each case should be chosen from the reconstructive ladder based on the technical difficulty level.

Aim To study the effects of Quercetin on the angioge ne sis and cultured human vascular endothelial cells (HUVEC).Methods In vivo, the effects of Quercetin on angiogenesis induced by vascular en dothelial growth factor (VEGF) and basic fibroblast growth factor(bFGF), were observ ed by chorioallantioic membrane (CAM) test. The effects of quercetin on proliferation of human vascular endothelial cells (HUVEC) were assessed by MTT assay. The effects of Quercetin on cell cycle of HUCEC were observed by flow cytometer (FCM ).Results The angiogenesis induced by VEGF in CAM was strongly inhibited by Quercetin with 0.1, 0.05 and 0.025 mmol?L -1; The angiogen esis induced by bFGF in CAM. was strongly inhibited by Quercetin with 0.1 and 0 .05 mmol?L -1. Quercetin markedly inhibited the proliferation of HUVEC with 240,120,60 and 30 ?mol?L -1. The inhibition rate was 67.0%,58.1% ,39.7% and 20.7% respectively. Quercetin at the concentration of 240 ?mol? L -1 and 120 ?mol?L -1 resulted in S,G 2 arrest of HUVEC. Conclusion Quercetin has substantial inhibitory effects on angiogenesi s induced by VEGF and bFGF, and on proliferation of HUVEC.

Objective To investigate the effects of early Xuebijing injection on procalcitonin (PCT) with septic shock patients.Methods Sixty-five patients with septic shock were randomly divided into the control group and Xuebijing injection group.The patients in Xuebijing injection group were received Xuebijing injection therapy(50 ml Xuebijing + 100 ml 0.9％ NaCl injection,2 times/d,for 7 d) besides basic treatment,while in the control group were received basic treatment including antibiotic susceptibility + early fluid resuscitation + correct acidosis.At the entering the ICU day and 1,3,5 d after treatment,patients were collected 5 ml venous blood serum C reactive protein(CRP) and PCT,and before treatment and at the 5th,7th day after treatment conducted APACHE Ⅱ evaluation to observation of curative effect of two groups.Results Before treatment,there were no significant difference in terms of heart rate,blood pressure,PCT,CRP,APACHE Ⅱ scores between the two groups (P ＞ 0.05).There was no significant difference in terms of PCT and CRP between the two groups at the 1 d after treatment(P ＞0.05).While at the 3th day after treatment,PCT and CRP of Xuebijing group were lower than of control group and the differences were significant ((7.37 ± 2.58) μg/L vs.(12.25 ± 3.32) μg/L,(64.32 ± 11.12) mg/L vs.(72.37 ± 12.42) mg/L;P ＜0.05).The APACHEⅡ score in control group at before and 5th,7th day after treatment were (20.48 ± 4.41),(16.52 ± 3.45),(12.78 ± 2.91) respectively,in Xuebijing injection group were (20.74 ± 4.73),(12.48 ± 2.76),(9.24 ± 6.67) respectively.And all indices were significant different time points between groups (P ＜ 0.05).At 7th day after treatment,15 cases were improved,10 cases progressed and 8 cases died in the control group and the effect rate was 75.8％ (25/33).Meanwhile,22 cases were improved,5 cases progressed and 5 cases died in the Xuebijing group and effect rate was 84.8％ (27/32).There was significant difference between two group(x2 =7.27,P =0.03).Conclusion Early Xuebijing injection application can inhibit the PCT r~tion of septic shock patients and improve the prognosis.