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.

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.

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-.

Objective To study the clinical effects of recombinant human epidermal growth factor (rhEGF) gel combined with tacrolimus treatment on facial hormone-dependent dermatitis, and to investigate its influence in skin function and recurrence of dermatitis. Methods Forty-eight outpatients with facial hormone-dependent dermatitis were randomly divided into treatment group (n=24, treatment with tacrolimus combined rhEGF gel) and control group (n=24, treatment with tacrolimus). The moisture of skin, sebum content and transepidermal water loss (TEWL) were examined before treatment and 4 weeks after treatment in two groups. Eczema area and severity index (EASI) were calculated at 1 week, 2 weeks and 4 weeks after treatment. The adverse reactions and recurrence of dermatitis were observed during the treatment as well. Results Compared with pre-treatment, the moisture of skin and sebum content were increased (P<0.05) and the TEWL was decreased (P<0.05) after 4-week treatment. The differences were not statistically significant between two groups. The obvious effective rate of the treatment group (45.8%) was not significantly different from that of the control group (20.8%) after 1 week of treatment (P>0.05), but it is much higher in treatment group after two-week treatment (79.2%vs. 50.0%, P<0.05) and after four-week treatment (91.2% vs. 62.5%, P<0.05). Furthermore, there was no adverse reaction in the treatment group, and the recurrence rate was much lower in treatment group (12.5%) than that of the control group (37.5%,χ2=4.03,P<0.05). Conclusion Recombinant human epidermal growth factor gel has an auxiliary curative effect on facial hormone-dependent dermatitis and can significantly improve skin function, and the recurrence rate of dermatitis is low.

The incidence rate of young women with breast cancer is increasing.Because of distinct biological characteristics of breast cancer in young patients,it is reasonable to identify who is the best one for breast-conserving surgery.Patients with systemic chemotherapy should be fully considered about fertility requirements.In addition,endocrine therapy combined with ovarian function inhibition can improve the effect,meanwhile,there should increase the proportion of patients with targeted therapy.

Objective To explore the effect of serum uric acid ( UA ) level and its change in the incidence of nonalcoholic fatty liver disease( NAFLD) . Methods Subjects who participated in the adult health examination in a Top Three Hospital Medical Center of Guangzhou Province in 2012 and 2015, according to whether they have suffered from NAFLD after 3 years follow?up,were divide into NAFLD incidence group and negative control group. The data of anthropometry, laboratory examination and abdominal ultrasound were retrospective analyzed. Results There were 91 male in NAFLD incidence group and 317 males in negative control group. There were statistical significance in body weight ( Wt ) , BMI, UA, TG, HDL?C at baseline ( t=6. 10,4. 98,4. 21,1. 91,-4. 06;P<0. 05). According to UA<149 μmol/L,more than or equal to 149 to<416μmol/L,more than or equal to 416μmol/L as grouping standard,males detection of NAFLD in each group were 0 case,55 cases ( 19. 1%) , 36 cases ( 30. 3%) , and the difference was statistically significant compared with negative control group(χ2=6. 28,P=0. 012). According to UA<89 μmol/L,more than or equal to 89 to <357μmol/L,more than or equal to 357 μmol/L as grouping standard, females detection of NAFLD in each group were 0 case,91 cases( 20. 0%) ,39 cases( 37. 9%) ,and the difference was statistically significant compared with negative control group(χ2=14. 87,P=0. 001) . Age?adjusted partial correlation analyze showed that serum UA levels were positively correlated with Wt,BMI,SBP,DBP,BUN,SCr,ALT,TG and LDL?C levels,and negatively correlated with HDL?C levels( r=0. 349,0. 248,0. 152,0. 157,0. 201,0. 251,0. 132,0. 191,0. 148,-0. 228,P<0. 05) . There was no statistical significance between the NAFLD incidence group and the negative control group in the change of serum UA( z=0. 811,P=0. 417) . Binary Logistic regression analyze showed that the incidence of NAFLD was closely related to BMI,UA,ALT,TG and HDL?C at baseline,and the changes of Wt,ALT,TG, HDL?C during follow?up ( OR ( 95%CI ): 0. 767 ( 0. 709-0. 830 ) , 0. 996 ( 0. 994-0. 998 ) , 0. 964 ( 0. 937-0. 992),0. 702(0. 516-0. 955),4. 948(2. 414-10. 144),0. 890(0. 852-0. 930),0. 957(0. 937-0. 979), 0. 601(0. 441-0. 818),3. 111(1. 197-8. 080),P<0. 05). Conclusion Serum UA level is closely related to the incidence of NAFLD and its related risk factors, and serum UA level is an independent risk factor for NAFLD.

Objective To compare the anesthetic effect of different inserting time on patients under propofol combined sufentanil anesthesia in gastroscopy.Methods A total of 120 out-patients aged 18-60 years underwent gastroscopy were randomly divided into two groups (A and B,60 cases each).They received sufentanil 0.1μg/kg combined with propofol 1.5 mg/kg intravenously.Gastros-copy was inserted into patients’mouth immediately when the patients’consciousness lost and eyelash reflex disappeared (group A)or 30 s later (group B).When necessary (cough or movement),addi-tional propofol 0.5 mg/kg was added to enhance and maintain anesthesia.HR,BP and SpO2 were re-corded before induction (T0 ),before inserting (T1 ),gastroscopy passing through throat (T2 )and after procedure (T3 ).We observed and recorded cough,hiccup,body movement,recovery time and total dosage of propofol.Results Compared with T0 ,MAP (T1 )of both groups were lower (P <0.05).There was no statistic different in MAP on T2 and T3 .There was no statistic different in HR, MAP and SpO2 on T0-T3 between two groups.The incidence of cough and body movement were lower in group B than in group A (P <0.05).Group B had shorter recovery time and less propofol usage than group A (P <0.05).Conclusion Inserting gastroscopy 30 s after consciousness and eyelash re-flex disappear in propofol combined sufentanil anesthesia can reduce the incidence of cough and move-ment,reduce propofol consumption,and shorten recovery time but without respiratory and haemody-namic adverse effects.

Inflammatory bowel disease(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),is characterized by chronic non-specific inflammation of intestinal tract,which is incurable and easily relapsing. Recently,the role of gut microbiota in IBD has become a hot spot of study. This article reviewed the advances in study on intestinal microbiota in intestinal homeostasis and IBD.

Objective To explore the clinical value and the correlation of parathyroid hormone and osteocalcin in hemodialysis patients.Methods According to the dialysis duration of hemodialysis patients,they are divided into the four groups,Ⅰ (dialysis time ＜2 years),Ⅱ (dialysis time 2-5 years),Ⅲ(dialysis time ＞5-10 years),Ⅳ (dialysis time ＞ 10 years),50 cases were randomly selected from each group,50 cases of healthy people were taken as a control group,to detect the contents of PTH and N-MID in serum and analyze the results.Results The content of PTH in hemodialysis patients of Ⅰ,Ⅱ,Ⅲ,Ⅳ group were (170.9 ± 45.9) ng/L,(405.4 ± 65.3) ng/L,(717.1 ± 199.6) rng/L,(1 555.6 ± 417.8) ng/L,the content of N-MID were (79.23 ± 31.62) μg/L,(140.22 ± 50.98) μg/L,(496.11 ± 159.49)μg/L,(617.9 ± 386.18)μg/L,the content of PTH and N-MID in control group were (6.85 ± 3.74) ng/L,(16.6 ± 8.57) μg/L,PTH and N-MID levels of the four hemodialysis patients groups were significantly higher than those of normal control group,the differences had statistically significance(PTH levels of the four groups compared with the control group:group Ⅰ compared with the control group,t =25.199,P ＜0.01 ;group Ⅱ compared with the control group,t =43.091,P ＜0.01 ;group Ⅲ compared with the control group,t =25.402,P ＜0.01 ;group Ⅳ compared with the control group,t =26.211,P ＜0.01 ;N-MID levels of the four groups compared with the control group:group Ⅰ compared with the control group,t =13.518,P ＜ 0.01 ; group Ⅱ compared with the control group,t =16.909,P ＜ 0.01 ; group Ⅲ compared with the control group,t =21.229,P ＜ 0.01 ; group Ⅳ compared with the control group,t =11.007,P ＜ 0.01),the content of PTH and N-MID in Ⅰ,Ⅱ,Ⅲ,Ⅳ groups had statistically significance (four groups of PTH levels compare to each other:group Ⅰ compared with group Ⅱ,t =20.774,P ＜0.01 ;group Ⅰ compared with group Ⅲ,t =18.858,P＜0.01;group Ⅰ compared with group Ⅳ,t =23.295,P＜0.01;groupⅡ compared with group Ⅲ,t =10.495,P ＜ 0.01 ; group Ⅱ compared with group Ⅳ,t =19.233,P ＜ 0.01 ; group Ⅲ compared with group Ⅳ,t =12.805,P ＜ 0.01 ; Four groups of N-MID levels compare to each other:group Ⅰ compared with groupⅡ,t=7.189,P ＜0.01;group Ⅰ compared with group Ⅲ,t =18.130,P ＜0.01 ;group Ⅰ compared with group Ⅳ,t =9.830,P ＜ 0.01 ;group Ⅱ compared with group Ⅲ,t =15.029,P ＜ 0.01 ;group Ⅱ compared with group Ⅳ,t =8.671,P ＜ 0.01 ; group Ⅲ compared with group Ⅳ,t =2.061,P ＜ 0.05).Conclusion PTH levels were positively correlated with N-MID content in hemodialysis patients,high PTH hemodialysis patients should prevent osteoporosis early and to take appropriate treatment.

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.