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.

Autologous hematopoietic stem cell transplantation(AHSCT) has a good curative effect for high-risk or middle-risk aggressive lymphoma,but some patients who receive AHSCT still died of recurrence.The main reason for this is the presence of minimal residual disease (MRD), including residual tumor cells in vivo and contamination of grafts with tumor cells.Rituximab can be targeted to remove CD_(20) positive B cells,so application of rituximab before and after AHSCT may play a role in removal of residual disease and in vivo purging.Bituximab combined with AHSCT may further enhance the curative effect for CD_(20) positive B cell lymphoma.

Objective To investigate the relationship between single nucleotide polymorphism (SNP) at position + 10225 in adiponectin receptor 1 gene and type 2 diabetes.Methods The genotypes of + 10225C/G of adiponectin receptor 1 were detected by polymerase chain reaction with sequence specific primers (PCR-SSP) in 200 type 2 diabetes and 100 health controls.Fasting blood samples of all cases were obtained to extract DNA and detect genotype.Statistical software spss 13.0 was used to analyzed.Results Frequency of G-type allele in type 2 diabetes was 40.5％,that in normal controls was 23.5％,there was significant diffierences in the genotype frequencies of SNP+10225 between type 2 diabetes and health controls (x2 =128.0,P＜0.01).Conclusion AdipoR1 + 10225C/G polymorphism was probably associated with type 2 diabetes,G-type allele might be a genetic risk factor of type 2 diabetes.

Objective To evaluate the effects of dexmedetomidine on inflammatory responses in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Thirty ASA physical status Ⅱ or Ⅲ patients of both sexes,aged 45-64 yr,weighing 50-80 kg,scheduled for elective cardiac valve replacement with CPB,were equally and randomly divided into 2 groups using a random number table:control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with iv injection of midazolam,sufentanil,etomidate and rocuronium.The patients were endotracheally intubated and mechanically ventilated.A loading dose of dexmedetomidine 1 μg/kg was injected intravenously over 10 min after induction,followed by continuous infusion at 0.05 μg· kg-1 · h-1 until the end of operation in group D.While the equal volume of normal saline was given in group C.Anesthesia was maintained with inhalation of sevoflurane,iv infusion of sufentanil and intermittent iv boluses of rocuronium.Before induction (T0),at 10 min after termination of CPB (T1),at the end of operation (T2),and at 6 and 24 h after operation (T3,4),the jugular bulb venous blood samples were taken for determination of serum concentrations of tumor necrosis factor-apha (TNF-α),interleukin-6 (IL-6),S100β protein and neuron-specific enolase (NSE).Results Compared with group C,the serum TNF-α concentrations at T1 4,IL-6 concentrations at T24,S100β protein concentration at T3,4 and NSE concentration at T1,2 were significantly decreased in group D (P ＜ 0.05).Conclusion Dexmedetomidine infused at 0.05 μg· kg-1 · h-1 after a loading dose of 1 tg/kg can reduce inflammatory responses,thus reducing cerebral injury in patients undcrgoing cardiac valve replacement with CPB.

This study was aimed to observe the therapeutic effect of Bushen Tiaogan of traditional Chinese medicine (TCM) herbs combined with clomiphene citrate therapy of promoting small follicular development. A total of 70 small follicle ovulation infertility cases were randomly divided into the control group of 35 cases with the treatment of clomiphene citrate of 50 to 100 mg for 5 days, and 35 cases in the treatment group with TCM herbal medicine of Radix Polygoni Multiflori, Lycium c hinense , eucommia, bupleurum root, turmeric, Fructus aurantii to nourish the kidney and regulate the liver. The clinical efficacy and maximum follicular diameter (MFD) were observed. The results showed that the cycle pregnancy rate in the treatment group was 43 . 59%, and 35 . 13% in the control group. The curative effect of treatment group was obviously superior to the control group. There was statistical significance in the curative effect ( P < 0 . 05 ) . The incidence of LUFS was 7 . 69% in the treatment group , and 29 . 73% in the control group . There was statistical significance ( P < 0 . 01 ) . The MFD value ( 18-28 mm ) in the ovulation cycle, the cycle pregnancy rate was 44.44% in the control group and 55.17% in the treatment group. There was statistical significance difference ( P < 0 . 05 ) . The early abortion rate was 18 . 75% in the control group and 6.25% in the treatment group. There was statistical significance difference (P < 0.01). It was con-cluded that Bushen Shugan Y angyin TCM herbs combined with clomiphene citrate can promote small follicular development with obvious clinical curative effect .

Objective To investigate the influence and clinical effect of assisted three-dimensional conformal radiation therapy (3D-CRT ) on obstructive jaundice caused by malignant tumors .Methods 90 cases with obstructive jaundice caused by malignant tumors of liver ,gallbladder and pancreases were randomly divided into observation group and control group ,45 cases in each group . Patients in control group were given comprehensive measures ,including tumors exairesis ,assisted chemotherapy and stereotactic ra-diotherapy ,and patients in observation group were given 3D-CRT based on tumors exairesis and assisted chemotherapy .Clinical effect ,serum bilirubin were observed 2 months after treatment ,adverse reactions were recorded during the treatment ,and survival rate in 2-year follow up in two groups were observed .Results Total effective rate in observation group and control group were 75 .56% and 57 .78% (P<0 .05) ,respectively ,and adverse reactions rate were 37 .78% and 57 .78% (P<0 .05) ,respectively .After treatment ,serum total bilirubin and direct bilirubin in two groups were all lower than those before treatment (P<0 .05) .Serum total bilirubin and direct bilirubin in observation group after treatment were (26 .3 ± 6 .5)μmol/L and(18 .9 ± 3 .3)μmol/L ,and were (39 .3 ± 9 .5)μmol/L and(26 .9 ± 6 .7)μmol/L in control group ,and there were statistical difference between two groups (P<0 .05) . Observation group′s survival rate was higher than that of control group (P<0 .05) .Conclusion It has good clinical effect of trea-ting obstructive jaundice caused by malignant tumors by 3D-CRT ,and it prolongs the survival time ,decreases serum bilirubin and improves jaundice symptom ,so it has some guiding significance to its treatment .

Objective To assess the informed consent about risks of pressure ulcers so as to effectively prevent pressure ulcers and reduce the disputes between the nurses and patients.Method An in-depth interview was conducted among 12 senior nurses in the operating room,the interview content recorded and analyzed to summarize some themes.Results In the link of informed consent on pressure ulcers,6 problems were found,e.g.,the standardization of methods for informed consent and the content,pressure ulcer risk assessment scale special for clinical specialties,lack of complementarity of assessment and prevention measures,importance of clear signature on the informed consent,time for informed consent signature,attitude of the families and the skills on answering related questions.Conclusions The implementation of the informed consent about the risk assessment of the pressure ulcer for surgical patients depends on the specification of the conversation,and the assessment scale special for the clinical specialties.Both improved preventive measures and preventive ability of the pressure ulcers are of great importance.

Small GTP binding protein Rho and its downstream Rho-kinase pathway play an important role in the various cellular functions, including contraction, migration, proliferation, adhe-sion and apoptosis, etc. This article reviews the role of Rho/Rho-kinase pathway in the pain generation and development and clinical application of Rho/Rho-kinase inhibitors. It discusses the feasibility of Rho/Rho-kinase as a target for analgesics. Ac-cumulating experimental and clinical evidences indicate that Rho/Rho-kinase pathway is involved in the neuropathic pain, inflammatory pain, diabetic painful neuropathy, cerebral vaso-spasm, vasospastic angina and cancer pain, etc. Therefore, Rho/Rho-kinase is a potential drug target of the pain, and it provides new therapeutic treatments and strategies for pain in clinic.