Objective To investigate the effect of atovastatin combined with trimetazidine on cardiac function and inflammatory cytokines in patients with chronic heart failure(CHF). Methods Ninety-seven patients with CHF were randomly divided into three groups:control group treated with conventional therapy,atovastatin group treated with atovastatin based on conventional therapy, and combined treatment group treated with atovastatin and trimetazidine based on conventional therapy. The parameters of cardiac function, including left ventricular ejection fraction ( LVEF) and left ventficular end-diastolic diameter (LVEDD) ,and the plasma levels of CRP,brain natriuretic peptide(BNP) ,and TNF-α were detected in all patients of each group before and after treatment. Results The plasma levels of CRP,BNP and TNF-α in patients with cardiac function Ⅳ were significantly higher than in those with cardiac function ≤ Ⅲ (P<0. 05). There was significant difference in plasma levels of CRP, BNP,TNF-α,LVEF and LVEDD before and after treatment in all groups(P<0. 05 or P<0. 01). As compared with control group after treatment,the plasma levels of CRP,BNP and TNF-α after treatment in both atovastatin group and combined treatment group were decreased markedly(P<0. 05),so did LVEF, LVEDD and 6-min walk test(P<0. 05). There was no significant difference in changes of CRP,BNP and TNF-α plasma levels,LVEF and LVEDD between atovastatin group and combined group after treatment (P>0. 05),but 6-min walk test lengthened statistically in combined treatment group (P<0. 05). Conclusion Atovastatin based on conventional therapy may play a role in anti-inflammation by lowering the plasma levels of CRP, BNP and TNF-α in patients with CHF, thereby improving cardiac function. Atovastatin combined with tremetazidine could reduce the cardiac muscular oxygen consumption and raise the excise endurance in patients with CHF.

The research findings published by National Surgical Adjuvant Breast and Bowel Project have continued to change the clinical practice of early-stage breast cancer over the past decade.Sentinel lymph node biopsy has become the new surgical operation standard.The aromatase inhibitor adjuvant endocrine therapy cycle has been extended from 5 years to 10 years, which benefits the patients with high risk and reactivity.Chemotherapy combined with trastuzumab has become the standard adjuvant therapy strategy of human epidermal growth factor receptor-2-positive invasive breast cancer.In addition, the research progress is also related to the optimization of the fields including the postoperative adjuvant chemotherapy and neoadjuvant chemotherapy.

Objective To evaluate the complication rate of secondary surgery in patients with benign thyroid disease. Methods From June 1992 to June 2003, 65 patients underwent reoperation. Operative procedures. pathology and complications were reviewed. Results The first surgery was unilateral in 27 cases (41.5%), bilateral in 38 (58.5%). Reoperation identified carcinoma in 8 cases with complications developed in 8 cases and left over permanent in 1 case (1.5%). Conclusion The complication rate of second operation is higher than that of first thyroid surgery, but still acceptable.

Objective To explore if Ulinastai reverses hepatofibrosis in rats.Method Rat hepatofibrosis models were induced by TAA subcutaneously injection.18 rats with hepatofibrosis were divided into 2 groups,Ulinastai treatment group (9 rats),normal saline control group (9 rats).AST,ALT,HA,SOD,MDA,LN level were measured and compared between the 2 groups and that of healthy rats (3 rats).Rats liver morphology was observed using HE,Masson stain and type-B ultrasonic.TGF-β1、caspase-3 were detected by immunohistochemistry.Result After 3 weeks Ulinastai treatment,elastic index and SSS score in Ulinastai group decreased significantly compared to pretreatment (t =2.472,P ＜0.05).ALT,AST,SOD,MDA,HA and LN level significantly improved (F =3.862,5.774,3.442,4.157,4.173,3.674,P ＜ 0.05).Compared with NS treatment group HE and Masson staining showed fewer inflammatory cells infiltration in central vein,ballooning degeneration of liver cells,collagen proliferated,hepatic lobules degradation and pseudolobule arise after 3 weeks intervenion.Also in Ulinastai group,TGF-β1、caspase-3 positive cells were much less than that in NS treatment group.Conclusions Ulinastai can reverse rat hepatic fibrosis and alleviate fibrosis degree and collagen fiber deposit.

Objective To investigate the serum level of visfatin, C-reactive protein (CRP) and monocyte chemoattractant protein-1 (MCP-1) in patients with polycystic ovarian syndrome (PCOS), and provide the basis for understanding the pathogenesis of PCOS. Meth-ods 94 patients with PCOS and 100 healthy subjects were divided into 4 subgroups according to their body mass index(BMI), including obese PCOS subgroup(n = 52), non - obese PCOS subgroup (n = 42), obese healthy subject subgroup (n = 43) and non - obese healthy subject (n = 57). Serum visfatin, CRP, MCP-1, sex hormone levels and metabolic parameters were measured by enzyme-linked immu-nosorbent assay (ELISA), automatic chemistry analyzer or chemiluminescent immunoassay. Results Serum levels of testosterone (T), lu-teiizing hormone (LH) and prolactin (PRL) in the PCOS group were significantly higher than those in healthy subjects group(P <0.05～0.01), and follicle-stimulating hormone (FSH) levels were significantly decreased in PCOS group(P<0.01). Serum levels of Visfatin, CRP, MCP-1,fasting insulin(Fins) and insulin resistance homa model (HOMA-IR) in the obese or non - obese PCOS subgroup were signif-icantly increased than that in the obese or non - obese healthy subjects subgroup respectively (P<0.01). Pearson correlation analysis showed that the visfatin, CRP and MCP-1 levels were positively related to BMI, FINS and HOMA-IR(r=0.323～0.675, P<0.01). Par-tial correlation showed that serum visfatin levels were correlated with HOMA-IR(r=0.491, P<0.01), and serum MCP-1 levels were cor-related with LH (r=0.267, P<0.05) in the PCOS group. Conclusion The patients with PCOS had higher visfatin, CRP and MCP-1 lev-els, and visfatin levels were positively correlated with insulin resistance. Obesity were involved in the chronic inflammation course in patients with PCOS.

Objective To investigate the effect of β-lactam antibiotics on the false positive rate of the serum Aspergillus galactomannan (GM) assay in patients with lung diseases.Methods We selectively recruited 77 lung disease patients who did not meet the diagnostic criteria of invasive pulmonary Aspergillosis (IPA) and received different β-lactam antibiotics,while 41 patients without IPA who did not receive any antibiotic treatment were recruited as the control group.Serum samples for GM detection were collected from all participants.The rate of false-positive Aspergillus galactomannan was compared between the two groups.Results False-positive serum results were found in patients who received piperacillin-tazobactam (30.8％ or 8/26) and cefoperazone sulbactamand (27.8％ or 5/18).The rate of false-positive Aspergillus galactomannan in patients who receive β-lactam antibiotics were significantly higher than that in the control group (24.7％ or 19/77vs.7.3％ or 3/41,x2 =5.315,P=0.025).Taking false-positive serum Aspergillus galactomannan as the dependent variable and β-lactam antibiotic treatment as the independent variable,univariate logistic regression analysis showed that the rate of false-positive Aspergillus galactomannan in patients who received β-lactam antibiotics were 4.149 times more than that in the control group (OR=4.149,P=0.030).Conclusions The administration of β-lactam antibiotics may increase the occurrence of false-positive serum Aspergillus galactomannan,and physicians should be aware of this possible interference.

Objective To screen potential serum HCC associated proteins with low molecular weight and low abundance for better understanding the pathological mechanism of HCC and discovering new biomarkers.Methods All serum samples were collected from 81 HBV-related HCC patients,43 chronic hepatitis B patients and 36 cirrhosis patients.Serum protein fingerprint profiles were first generated by selected WCX2 protein chip integrating with SELDI-TOF-MS,and then normalized and aligned by Ciphergen SELDI Software 3.1.1 with Biomarker Wizard.Comparative analysis of the intensity of corresponding protein fingerprint peaks in normalized protein spectra was performed.Some protein peaks with significant difference among HCC,cirrhosis and chronic hepatitis B groups were found.The reproducibility of the SELDI system was assessed before serum protein fingerprint profiles analysis.Results The intra-and inter-assay CV for intensity and m/z in this SELDI system were 17.46% and 0.024%,and 17.74% and 0.024% respectively.Total 128 protein fingerprint peaks between 2 000 to 30 000 Da were identified under the condition of signal to noise＞5 and minimum threshold for cluster＞20%.Eighty-seven proteins were found to significantly expressed between HCC and cirrhosis groups(P＜0.05).Of the above differential proteins,forty-five proteins had changes greater than two fold,including 15 up-regulated proteins and 30 downregulated proteins in HCC sera.Between HCC and chronic hepatitis B groups,nine of fifty-two differential proteins(P＜0.05) had intensities of more than two folds,including 2 up-regulated proteins and 7 downregulated proteins in HCC sera.Between cirrhosis and chronic hepatitis B groups,twenty-eight of seventynine significantly differential proteins(P＜0.05) changed greater than two folds in intensity,including 17 up-regulated proteins in cirrhosis seru and 11 down-regulated proteins in chronic hepatitis B sera.Analysis of above leading differential proteins among three diseases using subtraction difference mode,the 5 common down-regulated proteins 2 870,3 941,2 688,3 165 and 5 483 m/z in HCC sera and 2 common up-regulated proteins 3 588 and 2 017 m/z in cirrhosis and HCC sera were screened.But no statistic difference in the level of protein 2 017m/z was found between HCC group and normal group inour previous study.Conclusion Because the interference of unspecific proteins from hepatitis B and cirrhosis could be eliminated partly in HCC sera through subtraction difference analysis,these 6 common differential proteins (2 870,3 941,2 688,3 165,5 483,3 588 m/z)have obvious advantages of increased specificity for evaluating the pathological state of HCC and might become promising candidate biomarkers in the diagnosis of HCC.

Objective To appraise and compare protein expression profiles in sera of patients without or with recurrence following liver transplantation for hepatocellular carcinoma (HCC) using SELDI-TOF-MS technique,and establish the diagnostic and predictive model. Methods A total of 76 sera (41 from disease free survival patients and 35 from recurrence individuals) were collected pretransplantation and differentially expressed proteins were identified by SELDI-TOF-MS. The intensity values for each peak were analyzed by Biomarker Wizard Software to screen serum proteome biomarkers related to the recurrence post-transplantation. By using Biomarker Patterns Software, the classification trees were generate. from randomly selected samples (30 fingerprints obtained from each group). The sensitivity and specificity of best decision tree were then chosen for blind test with 16 samples (5 from recurrence individuals and 11 from recurrence-free survival patients). Results There were significant differences only in tumor size and the presence of vascular invasion between recurrence group and recurrence-free survival group (P＜0.05). According to serum protein fingerprints, a total of 368 protein peaks were identified at the mass-to-charge ratio (M/Z) value ranging from 2000 to 300 00. There were 22 significant differential proteins between two groups. Among them, 9 proteins were up-regulated and 13 proteins were down-regulated -espectively in recurrence group. The intensity values of differential proteins were input into BPS for classification tree analysis and the best performing tree could distinguish two groups successfully. As a result of blind assessment for this model,a sensitivity of 80.0 % (4/5) and specificity of 72.7 % (8/11) were obtained. Conclusion Some of differential proteins screened by SELDI-TOF-MS technique in the serum may be correlated with the prognoses of liver transplantation patients with HCC. The decision tree may be useful for the clinical application of formulating the indication for liver transplantation, detecting extrahepatic micrometastasis and setting up the diagnostic and treatment strategies.

Objective To evaluate the efficacy of the bacterial lysate Broncho-vaxom on chronic obstructive pulmonary disease(COPD)in elderly patients.Methods A total of 150 patients with stable COPD were randomized into the Broncho-vaxom group(n=78)treated with Broncho-vaxom as add-on to conventional treatment and the control group(n=72)treated with conventional treatment.The number of acute exacerbation of COPD per patient per year,quality of life,lung function,T cell subsets were evaluated for the therapeutic effects.Results After one year of treatment,the number of acute exacerbation per patient per year was lower in Broncho-vaxom group than in control group[(1.44 ± 1.05) times/y vs.(1.82 ± 0.61) times/y,t =2.754,P =0.007].The proportions of acute exacerbationfree patients were higher in Broncho-vaxom group than in control group(20.5％ or 16/78 vs.4.2％ or 3/72,x2 =9.043,P =0.003).There were significant differences in the forced vital capacity(FVC),forced expiratory volume in one second(FEV1),and forced expiratory volume in one second/predicted value ratio(FEV1 ％)between the two groups at 5 different time points(before,at 3,6,9 and 12 months after treatment) (Broncho-vaxom group:F =90.819,50.674 and 51.233,P =0.000;control group:F =84.928,90.654 and 86.117,P =0.000).After treatment,the symptom scores were lower in Broncho-vaxom group than in control group,and the ratios of CD4/CD8 T-cell were increased and level of CD8 T-cell was decreased in Broncho-vaxom group(all P ＜ 0.05).The rate of adverse reactions had no significant difference between Broncho-vaxom group and control group(3/78 or 3.8％ vs.2/ 72 or 2.8％,x2 =0.132,P=0.717).Conclusions The oral administration of Broncho-vaxom for six months can modulate and enhance immune functions,significantly decrease acute exacerbation frequency,improve quality of life and delay the deterioration in lung function in elderly patients with stable COPD.

OBJECTIVETo report a case and a firstly described pedigree with Ehlers-Danlos syndrome in China.

METHODSClinical materials of a case of Ehlers-Danlos syndrome type IV and a pedigree of 6 members with 4 generations were analyzed. Dilated internal jugular vein in the proband was removed operatively. The diagnosis, surgical treatment, and postoperative complications were retrospectively summarized. Etiology, clinical characteristics and classification of Ehlers-Danlos syndrome were also analysed.

RESULTSVessels of the proband in the pedigree were crisp and easily lacinated during the precedure for removal of his internal jugular vein. Repeat postoperative hemotomas were found though complete stanching was made during operation. The patient successfully recovered after prompt debridement in operative theatre and needle sucking. The other 5 members of the pedigrees all had the triads of Ehlers-Danlos syndrome, but no combined vascular diseases were found in them.

CONCLUSIONSThough the morbidity rate was extremely low, green attention should be paid to the high mortality rate and complication of Ehlers-Danlos syndrome during surgical management of in patients with Ehlers-Danlos syndrome type IV. Surgeons should be aware of the ponderance of its complications and combined diseases to avoid fatal intraoprative vascular lacination and incontrollable hamorrhage.