Objective To investigate the distribution of two single nucleotide polymorphism(SNP)-717A/G and-390C/A/T-within the C reactive protein(CRP)promoter region in ethnic Han Chinese and the association with coronary heart disease(CHD).Methods Altogether positive CHD patients and negative controls were studies in this study.The two target fragments were amplied by PCR.Then the-717A/G polymorphism was screened by restriction fragment length polymorphism(RFLP)and the-390C/A/T polymorphism by Sequence Specific PCR(SSP).At last,the association was studied by proper statistical analysis.Results There was no significant difference in the distribution of-717A/G polymorphism betweenpatients and controls.However,the frequencies of allels in-390C/A/T polymorphismwere significant different between them(P

To improve the knowledge of students and strengthen the teaching effects of internal medicine teaching,the characters,teaching methods and notices of clinical guideline were analysed. Moreover,according to previous teaching experiences,a few unique opinions on it were put forward. The results showed that clinical guideline was one of the most important ways in internal medicine teaching.

ObjectiveTo investigate the managements of complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA).MethodsData of 119 EA patients who underwent POEM from October 2010 to July 2011 were collected.Complications during and after POEM and during follow-up were analyzed.Results Complications during operation included bleeding in 19 patients ( 16.0％ ),mucosa rupture in 9 (7.6％),mediastinal and subcutaneous emphysema in 27 (22.7％ ) and pneumothorax in 3 (2.5％ ).Complications occurred at the night of procedure included pain in 43 (36.1％ ) patients and pneumothorax in 7 ( 5.9％ ).Postoperative complications included asymptomatic pneumothorax in 23 patients (19.3％),delayed hemorrhage in 1(0.8％),pleural effusion in 58 (48.7％ ),minor pulmonary inflammation or segmental atelectasis in 59 (49.6％),emphysema of mediasti-na and subcutaneous tissue in 76 (63.9％ ),and gas under diaphragm or aeroperitoneum in 47 (39.5％ ).Complications during follow-up included one case of dysphagia caused by stricture of mucosa and one case of dehiscence at the tunnel entry with food retention.No POEM-correlated death occurred.All the complications were cured by conservative treatments.No additional surgery was needed.ConclusionMain complications as emphysema of mediastina and subcutaneous tissue,pneumothorax,aeroperitoneum and bleeding during and after POEM can be treated timely and effectively with conservative treatment.

Objective To explore the role of ethyl pyruvate (EP) on E-cadherin of airway epithelium and airway inflammation in a TDI-induced mouse asthma model. Methods 30 male BALB/c mice were randomly divided into control group , asthma group and EP group. On day 1 and 8 , mice in asthma group and EP group were treated with 0.3%TDI on the dorsum of both ears for sensitization. And on day 15 , 18 and 21 the mice underwent an aerosol inhalation of 3% TDI, and saline (100 mg/kg) was injected intraperitoneally 1 hour before inhalation. The control group underwent acetone and olive oil (AOO) sensitization on day 1 and 8, AOO challenge on day 15, 18 and 21. Saline (100 mg/kg) was injected intraperitoneally 1 hour before challenge. One hour before each challenge, mice were given EP (100mg/kg) or vehicle via intraperitoneal injection. On day 22, airway reactivity, IL-4 , IFN-γand IgE in the serum were detected , immunohistochemistry and WB were used to assess E-cadherin levels. Results Airway reactivity, IL-4, IFN-γin and IgE in the serum in asthma group are significantly higher than that in control group (P<0.05). Treatment with EP dramatically decreased airway hyperresponsiveness in TDI-challenged mice, as well as IL-4, IFN-γ and IgE (P < 0.05). E-cadherin in control group was distributed evenly at the connection of epithelial cells. E-cadherinin distribution was chaotic and its expression was decreased in asthma group. EP intervention can ameliorate the damage of E-cadherinin. Conclusions EP can ameliorate the destruction of E-cadherin in airway epithilum by TDI.

Objective: To compare the efifcacy and safety of circumferential pulmonary vein antecourt isolation (CPVAI) ablation and stepwise linear (SL) ablation in treating the patients with atrial ifbrillation (AF) Methods: A total of 136 AF patients with catheter ablation under EnSite 3000 guidance in our hospital were retrospectively summarized. The patients included 93 paroxysmal AF and 43 persistent AF and divided into 4 groups. Paroxysmal AF with CPVAI ablation,n=45, Paroxysmal AF with SL ablation,n=48 and persistent AF with CPVAI ablation, n=18, persistent AF with SL ablation,n=25. The differences of left atrium diameter, ablation time, X-ray exposure time, the success rate and complication were compared among different groups. Results: For 12 months follow-up study, the success rate and complication were similar between 2 ablation methods for treating both Paroxysmal AF and persistent AF patients. For Paroxysmal AF patients, both ablation methods could effectively reduce left atrium diameter,P<0.01. The SL ablation had less procedural time than CPVAI ablation,P<0.01, while the X-ray exposure time was similar between 2 ablation methods. Conclusion: Both CPVAI and SL ablation methods were effective and safe for treating AF patients.

ObjectiveTo analyze the clinicopathological features and prognosis of gastric cancer patients with metastatic nodules of perigastric soft tissue. MethodsIn this study,1025 cases of gastric cancer received radical resection.According to the metastasis of perigastric soft tissue,patients were divided into metastatic group ( group MP,n =334 ),non-metastatic group ( group NMP,n =691 ).The clinicopathological features and prognosis were compared between the two groups. ResultsIn group MP,the ratio of upper,middle,lower,total gastric cancer was 25.8％,22.0％,51.4％,0.9％ and the ratio in group NMP was 33.2％,21.3％,41.3％,4.2％ respectively,showing significant higher ratio of upper and total gastric cancer in MP group(P =0.000). In group MP 47.3％ cases with tumor size ≥5 cm,significantly higher than that in NMP group(27％ ) (P =0.000).Lymph node metastatic ratio between 21％ -40％ and 41％ -100％ was found in 24.4％ and 37.3％ in MP group respectively,significantly higher than that of 12.9％,10.8％ in NMP group(P =0.000).20.1％ cases had distal metastasis in group MP,significantly higher than that of 4.1％ in group NMP(P=0.000).In group MP and NMP group,the ratio of Borrmann infiltration typing was 82.1％ vs.64.6％,the ratio of positive CEA was 21.2％ vs.11.4％,the ratio of lower or undifferentiation typing was 78.7％ vs.64.2％,all with significant difference (P =0.000 ). COX regression analysis showed the infiltration depth,organic invasion,lymph node metastatic ratio,M staging,Borrmann typing,metastatic nodules was the independent prognostic factors.Prognosis was significantly poorer in the cases with perigastric soft tissues than without ( P =0.000 ).Stratified analysis showed that irrespective of tumor size,infiltration depth,lymph node metastatic ratio,CEA value,Borrmann typing,differentiation degree,the mean survival time was significantly shorter in MP group than that in group NMP(P ＜ 0.005).In cases without distal metastasis,the prognosis was significant poorer in group MP than that in group NMP ( P =0.000 ),however,there was no significant difference between two groups in cases without distal metastasis ( P =0.076).ConclusionsPerigastric soft tissue metastasis was common in gastric cancer,more frequently seen in tumor ≥5 cm,or with organic invasion,lymph nodemetastaticration ≥ 21％, distalmetastasis, Borrmanninfiltrationtyping, loweror undifferentiation typing,positive CEA. Perigastric soft tissues metastasis was the independent prognotic factor for gastric cancer.

Objective To analyze the urine trace albumin(mALb)/creatinine(Cr) ratio and blood uric acid(UA),and other various metabolic index level in patients with diabetic nephropathy(DN),combined with clinical data such as patients' age,body mass index(BMI),course of diseases,to explore the related mechanism of occurrence and development of DN.Methods 76 DN patients were selected.The microalbuminuria group(urinary mALb/Cr<300μg/mg) had 46 cases,the clinical albuminuria group(urinary mALb/Cr≥300μg/mg) included 30 cases,another 49 diabetic patients without kidney damage were seleted as control group.The urinary mALb/Cr,blood UA,fasting blood glucose(FBG),triacylglycerol(TG),total cholesterol(TC),high-density lipoprotein(HDL),low density lipoprotein(LDL),glycosylated hemoglobin(HbA1c) levels were determined.The BMI and the length of the course of the disease calculate.Results The patients' age,course of the disease,urinary mALb/Cr,blood UA,FBG,TC,TG,LDL,HbA1c and BMI level in the clinical albuminuria group and microalbuminuria group were significantly higher than those in the control group,the differences were statistically significant (F=6.18,12.48,141.43,12.48,8.49,4.98,6.18,3.89,3.17,3.89,all P<0.05).The high uric acid hematic disease rates of the clinical albuminuria group and microalbuminuria group were 26.09% and 26.09%,which were significantly higher than 10.20% of the control group,the differences were statistically significant(x2=4.074,24.833,all P<0.05).Urinary mALb/Cr was positively correlated with age,duration,BMI,UA,TG,TC,LDL,FBG,HbA1c(r=0.120,0.299,0.148,0.340,0.157,0.149,0.103,0.487,0.103).Multiple linear stepwise regression analysis suggested that duration,blood UA,FBG were independent risk factors of urinary mALb/Cr;TG,BMI,urinary mALb/Cr were independent risk factors for blood UA.Conclusion Urinary mALb/Cr and blood UA are the independent risk factors,high uric acid hematic disease may participate in the development process of DN,and diabetes duration,UA,BMI,TG,TC,LDL,FBG,HbA1C associated with increased urinary mALb/Cr excretory DN patients,the effective monitoring can improve the symptoms of DN and quality of life.

Objective To investigate altered microstructural integrity in acute carbon monoxide(CO)intoxication by diffusion tensor imaging (DTI).Methods A total of 25 CO intoxication patients (5.0±1.44 post-intoxication)and 37 healthy volunteers matched with age, sex and educational level were involved and underwent DTI.The fractional anisotropy (FA)and apparent diffusion confficient (ADC) of total 26 regions of bilateral cerebellum,substantia nigra,hippocampus,white matter of frontal lobe,head of caudate nucleus,pallidum,thalamus, anterior limb of internal capsule,posterior limb of internal capsule,white matter of occipital lobe,white matter of parietal lobe,and genu of corpus callosum,splenium of corpus callosum were measured.Compared the patients against control for FA and ADC by paired t-test.Results FA of patients with CO intoxication decreased in bilateral pallidum,anterior limb of internal capsule,substantia nigra,right cerebellum,left below frontal white matter,right frontal white matter and genu of corpus callosum (P <0.05).ADC decreased in right substantia nigra,and left pallidum (P <0.05).ADC increased in right frontal white matter and bilateral occipital lobe white matter (P<0.05).Conclusion There is loss of microstructural integrity in acute CO intoxication,perhaps representing the underlying mechanism of delayed encephalopathy after carbon monoxide poisoning.

Objective To evaluate the efficacy and the feasibility of peroral endoscopic myotomy (POEM) for achalasia (AC). Methods The clinical data of 8 patients diagnosed as having AC and receiving POEM at our center from August 2010 to December 2010 were reviewed. The patients were 16-62 years old, mean 43yr, whose disease courses lasted for 2-20 years, mean 8.4 years. The key procedures of POEM were as the following, esophageal mucosal incision, submucosal tunneling by endoscopic submucosal dissection ( ESD), endoscopic myotomy of the circular muscle and closure of mucosal entry by hemostatic clips. Results All the 8 patients underwent POEM successfully. The mean operation time was 68.5 min ( ranging 45-115 min). The mean submucosal tunneling length was 9.5 cm ( ranging 8-13 cm). The average length of endoscopic myotomy of inner circular muscle was 8.5cm ( ranging 7-11 cm). No severe complications related to POEM occurred. Patients were followed up for 1-4 months ( mean 2. 5 months). Dysphagia was relieved significantly during the follow-up in 7 patients. But dysphagia and vomiting re-occurred in one patient 15 days after the operation. Endoscopy revealed a submucosal fistula, which was managed by incision. Conclusion As a new minimally invasive therapy for AC, POEM is very effective to relieve dysphagia in a short term. However, further observation is needed to evaluate long-term efficacy and complications.

Objective To evaluate the efficacy and safety of memantine in the treatment of patients with Alzheimer' s disease (AD).Methods This was a 16-week,multi-center,randomized,double blind, placebo-controlled clinical trial (Study 10116).A total of 258 AD patients (MMSE score 5—18) were randomized in a 1:1 ratio into either memantine 10—20 mg/day (MEM,n=128) or placebo (PBO,n= 130) group for 16 weeks.Efficacy was primarily assessed in terms of changes of severe impairment battery (SIB) score in patients from baseline up to SIB assessment in the 16th week (16-week completers set, CS16).While ehanges of MMSE,ADCS-ADL_(19),and NPI (neuropsychiatric inventory) were evaluated as secondary efficacy parameters on both CSI6 and full-analysis set (FAS).Safety was assessed by physical examination,lab assays,ECG,and adverse events.Results 236 subjeets (CS16:MEM n=117,PBO n=119) were eligible for the efficacy assessment.No statistically significant difference between the treatments was observed on the primary and seeondary efficacy analysis,although both treatment groups had a slight increase from baseline in SIB total score.Post hoe evaluation of the data identified two bias factors that had a significant impact on the results of the pre-protoeol specified primary and secondary analyses.In a re-analysis of the data (CS16_(modified),MEM n=94,PBO n=95) excluding patient data affeeted by these factors,memantine-treated patients showed a statistically significant improvement related to placebo in the 16th week on the SIB (MEM 2.2 vs PBO 0.3,P=0.04),MMSE (MEM 1.0 vs PBO 0.1,P=0.03),and ADL (MEM 0.1 vs PBO-1.6,P=0.02) scales,indicating that memantine improved the cognitive function of AD patients and stabilized the activity of daily life.Memantine was well tolerated with an adverse event profile similar to that of placebo.Conclusion This study provides further support for pre-existing data,showing that memantine is efficacious,safe,and well-tolerated in patients with moderate to severe AD.