Objective:To study the expression of angiotensin-converting enzyme(ACE),extracellular signal-regulated kinase(ERK),and the changes of atrial fibrosis in patients with rheumatic heart disease(RHD) and atrial fibrillation(AF) treated with angiotensin-converting enzyme inhibitor(ACEI).Methods:Atrial tissues were obtained from the right appendage during open surgery in 35 patients with RHD.The mRNA of ACE and ERK2 were semi-qualified by reverse transcription-ploymerase chain reaction(RT-PCR) and normalized to the glyceraldehyde 3-phosphate dehydrogenase(GAPDH).Western blotting analysis was employed to examine the expressions of ACE and phosphorylated ERK(pERK).Atrial collagen volume fraction(CVF) was detected by Masson's stain.Results:The mRNA of ACE and ERK2 or the protein of ACE and pERK were significantly increased,and CVF was significantly increased in patients with chronic atrial fibrillation(CAF) compared with sinus rhythm group(SR)( P 0.05).Conclusion:The expressions of ACE,ERK2 and pERK increase,and fibrosis is more severe in RHD patients with CAF as compared with those with SR.Compared with CAF patients treated without ACEI,the expressions of ERK2 and pERK significantly decrease( P 0.05)in CAF patients treated with ACEI.This suggests that the increasing expression of ERK2 and pERK resulting from local renal angiotensin-converting enzyme system activation mediates the development of atrial fibrosis,and ACEI may contribute to lesser atrial fibrosis in RHD patients with AF.

According to the sera aquaporin-4 antibody (AQP4), neuromyelitis optica (NMO) can be classified into two types as AQP4 antibody positive (AQP4+) and negative (AQP4-). However, the NMO patients with AQP4- are prone to delayed treatment, and may have a different pathogenesis compared to that in patients with AQP4+. Scientific researches and the clinical trials on NMO with AQP4- will deepen the understanding of NMO pathogenesis and help to make an early accurate diagnosis and rational therapy for NMO with AQP4-. This review aims to summarize the progress in clinic diagnosis for NMO patients with AQP4-.

Pulmonary hypertension (PH) is a progressive disorder characterized by abnormally elevated blood pressure of the pulmonary circulation. PH progresses rapidly to right ventricular (RV) failure and even death without treatment. Cardiac magnetic resonance (CMR) is an accurate and reproducible tool for the assessment of RV morphology and function, which plays an important role in the prognosis of patients with PH. The aim of this study is to review the clinical application and research progress of CMR in evaluation of PH.

Rho/Rho-kinase signaling pathway is a ubiquitous one in eukaryotic cells and plays a part in various biologic behaviors.Studies showed that it was expressed in pancreatic acinar,ductal and endocrine cells,as well as related to the pancreatic endocrine and exocrine functions.Moreover,the evidence showed that there was a close relationship the pathway and pancreatic cancer,pancreatitis,diabetes mellitus.

Objective To explore the characteristics,application and significance of electrocardiogragh (ECG)in diagnosis and differential diagnosis of pulmonary embolism(PE)by contrasting the ECG of PE and several diseases with similiar clinical features.Methods A total of 364 cases were enrolled in this study,including 197 cases of PE,70 cares of coronary artery disease(CAD)with congestive heart failure(CHF),47 cases of essential hypertension(EH)with CHF,and 50 cases of acute lung injury/acute respiratory distress syndrome(ALI/ARDS).The ECG of these 364 PE cases were analyzed.Results The rates of axle right drift,lockward rotation,right bundle branch block and pulmonary P wave,V1 lead s-wave were higher than control groups,with significant difference.Bates of S1Q3T3,disposition of T wave in chest lead were the highest in PE group,with significant difference.Conclusion The main appearances of ECG in PE patients hint the heavy load of right ventricular and coronary ischemia.Perhaps S1Q3T3 is the appearance of axle right drift.The sensitivity and speciality of every feature is not good enough to diagnosis or differential diagnosis;dynamic observation of ECG is of great significance to the diagnosis of PE.

This article expounds the indication,preoperative ischemic tolerance test,evaluation of collateral circulation,different surgical modes,complications and their prevention in the treatment of intracranial aneurysms during extracranial-intracranial(EC/IC)graft bypass.It is considered that EC/IC bypass graft is an effective therapeutic mode in preventing the occurrence of cerebral ischemia in the treatment of intracranial aneurysms.

Objective To evaluate the corneal astigmatism changes after phacoemulsification performed using clear corneal incision with different locations.Methods Seventy-two eyes of 72 patients having phacoemulsification and implantation of foldable intraocular lens through a clear corneal incision were chosen.Patients were divided into two groups by table of random digit:group A (incision at 11:00),group B (incision at the steepest corneal meridian).The change of corneal astigmatism was compared between group A and B postoperatively.Surgically-induced astigmatism (SIA) was calculated by vector analyses using the HoHaday-Cravy-Koch method.Results Preoperative corneal astigmatism between group A and group B had no significant difference [(0.96 ± 0.52) D vs.(0.94 ± 0.56) D,P ＞ 0.05].One and three months after operation,the corneal astigmatism in group A were significantly higher than those in group B [(1.15 ± 0.32)D vs.(0.82 ± 0.43) D,(0.85 ± 0.38) D vs.(0.63 ± 0.40) D,P＜ 0.05].The SIA in group A was significantly higher than that in group B 1 month after operation [(0.85 ± 0.37) D vs.(0.75 ± 0.54) D,P ＜ 0.05],there was no significant difference between group A and group B 3 months after operation [(0.60 ±0.35) D vs.(0.58 ±0.30) D,P ＞0.05].Conclusions Corneal astigmatism is prｅsent in most cataract surgery candidates.Cataract surgery using steepest corneal meridian incision induces significantly less SIA,and correct corneal astigmatism already present preoperatively.

Objective To compare the efficacy of the streamlined liner of the pharynx airway (SLIPA) and the proseal laryngeal mask airway (PLMA) in airway management in elderly patients undergoing laparoscopic cholecystectomy.Methods One hundred and twenty patients aged 60-75 years with American Society of Anesthesiologists (ASA) grade] or Ⅱ undergoing laparoscopic cholecystectomy were randomly divided into three groups:the endotracheal intubation group (Group T,n=40),the SLIPAgroup (GroupS,n=40) and the PLMA group (GroupP,n=40).Endotracheal intubation and laryngeal mask airway insertion were conducted after induction of anesthesia.All the patients were ventilated with intermittent positive pressure ventilation.Mean arterial pressure and heart rate were recorded at before induction (T0),successful insertion (T1),ten minutes after pneumoperitoneum (T2),successful extubation (T3),and ten minutes after extubation (T4).The rate of successful placement at first attempt,time taken for placement,airway sealing pressure,and side effects were recorded.The incidences of post-extubation cough,backflow,aspiration,larynogospasm,bleeding,gastric distension and sore throat within 2 days after intubation were also recorded.Results The successful rates of insertion were 92.5 ％,92.5 ％,95.0 ％,respectively,at first attempt and 100.0％ at second attempt in the three groups (x2 =0.268,P＜0.05).Changes in hemodynamic parameters were significantly different between Group T and Group S or P after induction (t=4.076,P＜0.05).Time taken for placement was shorter in Group S than in Groups T and P,meaning that the placement of SLIPA was easier than that of endotracheal intubation or PLMA (t=43.561,P＜0.05).The airway sealing pressure was higher in Group P than in Group S,but had no statistically significant difference between the two groups (t=0.363,P＞0.05).There was no significant difference in post extubation complications,including backflow,aspiration,laryngospasm and gastric distension (t=0.321,P＞0.05),among the three groups,but incidences of postextubation cough and pharyngalgia were higher in Group T than in Group S and Group P (x2 =26.674,10.568,P＜0.05).Conclusions SLIPA and PLMA can both provide adequate ventilation during operation,with few complications.SLIPA placement is the easiest,while PLMA has good airway sealing and thus is more suitable for elderly patients undergoing laparoscopic cholecystectomy.

BACKGROUND: Studies have proved that rotating magnetic field(RMF) can significantly increase bone mineral density(BMD) in rats, and such high BMD maintains for a long time which is independent of the actions of hormone.OBJECTIVE: To investigative the effect of RMF on bone calcium content and the correlation between bone-specific alkaline phosphatase(BAP) and deoxypyridinoline crosslinks (DPD) in rats.DESIGN: A randomized controlled study in rats.SETTING: A college of life sciences of a university.MATERIALS: The experiment was conducted in Shenzhen Key Lab of Microbiological Genetic Engineering from March 2004 to October 2004, using 90 healthy adult SD rats including 60 females weighing(259 ± 70) g and 30 males weighing (351 ± 104)g. The rats were randomly divided into 9 groups including 6 ovariotomy groups, namely female sham-operation group, normal calcium control group, low calcium control group, low calcium experimental group, normal calcium experimental group, and low calcium group with traditional Chinese medicine(TCM) treatment, besides a male control group,male low calcium experimental group, and male normal calcium experimental group, with 10 rats in each group.INTERVENTIONS: The female rats in each group, except for those in the sham-operation group, received ovariotomy. The rats in the ovariotomy control group had only ovariotomy. After metabolic exhaustion of the remnant estrogen on the 15th day, the rats in the ovariotomy experimental group were treated with RMF for 2 hours once a day for 15 days. The male rats, except for those in the control group, all bad RMF in identical manner. The rats were given food with normal calcium(containing 0.26% calcium), lower calcium (containing 0.1% calcium) and traditional Chinese medicine(powder of Fructus Psoraleae, Radix Astragali, epimedium herb, and herba cistanchis) .After RME treatment, the rats were fed for another 15 days before the femur was collected to measure the bone calcium content. Serum samples were also obtained for measuring the content of BAP and urine samples collected to measure the content of DPD.MAIN OUTCOME MEASURES: The bone calcium content of each group and serum BAP and urine DPD.RESULTS: Of the 90 rats used, 4 died during the experiment and 86 entered the result analysis. The bone calcium content was increased after RMF treatment, and the content in rats in the low calcium group with ovariotomy and TCM treatment and lower calcium control group with ovariotomy was(0.226± 0. 015) and(0. 206 ± 0. 015) g/g, respectively( t =4.63, P ＜ 0. 05). The bone calcium content in the male normal calcium experimental group and male control group was(0. 206 ±0. 031) and(0. 199 ±0. 014) g/g respectively ( t = 4.21, P ＜ 0.05 ) . After treatment with RMF, serum BAP content was increased and was(20. 52 ± 1.78) and(15.68 ±3.68) U/L in normal calcium experimental and control groups with ovariotomy, respectively( t=4.76, P ＜0.05), and(17.69±3.78) and (8.53±2.54) U/Lin the male low calcium experimental and male control groups, respectively( t= 4. 59, P ＜ 0.05). Urine DPD after RMF treatment was (86.97 ± 37.19)and(401.57 ±79. 34) nmol/L in the low calcium experimental group with TCM treatment and ovariotomy and the low calcium control group with ovariotomy, respectively( t =7.45, P ＜ 0.01), and(97.87 ±31.97) and (168.71 ±53.19) nmol/L in the male normal calcium experimental and male control groups respectively( t = 8.31, P ＜ 0.01 ).CONCLUSION: RMF can effectively increase bone calcium content in a short time( 15 days), and the effect was positively correlated with increased blood BAP and decreased urine DPD.

BACKGROUND: Nerve fiber degeneration and horseradish peroxidase antrograde tracing methods are commonly used to study nerve pathway. However, both the methods cannot mark the area clearly and lack of sensitivity so that they cannot fully present the projection area of nerve fibers. It needs further efforts on developing new nerve pathway tracing methods to effectively research nerve pathway.OBJECTIVE: To look for a highly sensitive method of nerve pathway tracing in order to provide a simple, objective and reliable method to study regeneration.DESIGN: A randomized and controlled trial based on experimental animals.SETTING: Department of Internal Medicine of a hospital and the Experiment technique teaching section of a university.MATERIALS: The experiment was completed in the Experiment Technique Teaching Section of Chengdu Medical College. Six healthy male SD rats provided by Experimental Animal Centre of West China Medical University were used.METHODS: Using CB-HRP as tracer while using sodium tungstate as stabilizer of TMP to antrograde tracing the projection of optic nerve fibers on anterior region of hypothalamus and retrograde tracing the distribution of hypoglossal nerve fibers on the dorsal side of medulla.MAIN OUTCOME MEASURES: Distribution and dyeing of neuron bodies and nerve fibers.RESULTS: The fibers of optic nerve projected to the dorsomedial side of suprachiasmatic nucleus and the fibers of hypoglossal nerve projected on the hypoglossal nucleus on dorsomedial portion of the medulla oblongate. The result shows that the neurons and axons are very clear.CONCLUSION: It is a highly sensitive method to trace nerve pathway by using CB-HRP as tracer and sodium tungstate as stabilizer of TMB.