Autoimmunity is influenced by genetic,immune,hormonal,and environmental factors.Viral infections may trigger autoimmunity.It has been established that autoimmunity may be a contributing factor in the pathogenesis of heart disease.Myocarditis is defined as inflammation of the heart muscle associated with impaired function of the myocardium.Myocarditis is considered as the most common cause of dilated cardiomyopathy.Myocarditis may be caused by infectious factors and noninfectious factors,noninfectious factors including autoimmune diseases with myocarditis.To gain a better understanding of autoimmune myocarditis,we summarize the pathogenesis and clinical significance of autoimmune myocarditis.

Humans ; Medicine, Chinese Traditional ; Nephrotic Syndrome ; diagnosis ; therapy

Objective To employ intraoperative discography to determine the injured intervertebral disc segments that can not be identified on the preoperative MRI in patients with cervical spinal cord injury without fracture and dislocation for confirming the responsible segments needing surgical decompression and fusion.Methods The study involved 85 patients with cervical spinal cord injury without fracture and dislocation treated from January 2007 to December 2011,among which sixteen patients had not been identified with the responsible segments by preoperative MRI.The average preoperative Japanese Orthopedic Association (JOA) score was (9.1 ± 1.8) points.There was no obvious fracture or dislocation of the cervical spine on preoperative X-ray film,CT and MRI,but all patients displayed high intense signal in cervical spinal cord on MRI T2 weighted imaging.Besides,MRI revealed hemorrhagic swelling of anterior cervical soft tissue in nine patients and cervical intervertebral disk hernia in all patients.Annulus fibrosus rupture of cervical intervertebral disc with contrast leakage in intraoperative discography of suspected injury segments in all patients under direction of C-arm X-ray machine was set as the injury criterion.The patients with pure ruptured discs received cervical discectomy,interbody fusion and titanium plate fixation.The patients associated with multilevel cervical intervertebral disc hernia or ossification of posterior longitudinal ligament underwent anterior cervical corpectomy,bone graft with titanium cageand titanium plate fixation of ruptured discs.Results Nineteen injured discs were identified eventually by discography,including 2 discs at C3/4,4 at C4/5,8 at C5/6 and 5 at C6/7.Moreover,anterior annulus fibrosus rupture with intact anterior longitudinal ligament was found in 11 patients.The follow-up lasted for (24.4 ± 10.0) months.JOA scores were (13.3 ± 1.5) points and (14.5 ± 1.6) points at two weeks and three months after operation,and (15.1 ± 1.5) points at the last follow-up,indicating a relevant improvement rate of 53％,68％ and 76％ respectively.Mean operation time was 110 minutes and blood loss was 120 ml.Three patients had pain on shoulder and back and one patient had hoarse voice,but all the patients were relieved in two weeks after conservative treatments.No serious complications,such as deep infection,deterioration of neurological dysfunction,vertebral artery injury or internal fixation failure were noticed intra-or post-operatively.Conclusion For the intradiscal rupture that is hard to be determined by the conventional imaging methods,intraoperative discography can be used as an auxiliary method of imaging diagnosis in early surgical determination of responsible segments for cervical spinal cord injury without fracture and dislocation.

Objective To investigate the effect of clemastine fumarate on lung ischemia-reperfusion (I/R) injury in rabbits.Methods Fifty New Zealand white rabbits of both sexes,weighing 2.0-3.0 kg,were divided into 3 groups using a random number table:sham operation group (Sham group,n =10),I/R group (n =20) and clemastine fumarate group (Cle group,n =20).The model of lung I/R was established by clamping the left hilum of lung and decreasing the tidal volume followed by restoration of perfusion and ventilation 1 h later in I/R and Cle groups.At 3 h of ventilation in group Sham and 2 and 4 h of reperfusion in I/R and Cle groups,blood samples were collected for determination of serum tumor necrosis factoralpha (TNF-α) and interleukin-8 (IL-8) concentrations by enzyme-linked immunosorbent assay.The left lung was lavaged,and the broncho-alveolar lavage fluid (BALF) was colleted for determination of white blood cell count.Lung specimens were obtained for microscopic examination of the ultrastructure of lung tissues and for determination of wet/dry weight ratio (W/D ratio),expression of IL-1β and IL-6 mRNA (by real-time polymerase chain reaction) and cell apoptosis (by TUNEL).The apoptosis rate was calculated.Results Compared with Sham group,the W/D ratio,white blood cell count in BALF,serum concentrations of TNF-α and IL-8 and apoptosis rate were significantly increased,and the expression of IL-1β and IL-6 mRNA was up-regulated in I/R and Cle groups (P＜0.05 or 0.01).Compared with I/R group,the W/D ratio,white blood cell count in BALF,serum concentrations of TNF-α and IL-8 and apoptosis rate were significantly decreased,and the expression of IL-1β and IL-6 mRNA was down-regulated in Cle group (P＜0.05 or 0.01).The pathological changes of lung tissues were significantly attenuated in Cle group than in I/R group.Conclusion Clemastine fumarate can attenuate lung I/R injury in rabbits.

Objective To explore the relationships among personality,coping style and clinicians' job burnout.Methods 1569 clinicians were investigated with Chinese Maslach Burnout Inventory,Eysenck Personality Questionnaire and Simple Coping Style Questionnaire.The data were performed with regression and path analysis.Results The proportion of burnout was 72.4％,the proportion of slight burnout was 36.5 ％,the proportion of moderate burnout was 31.2％ and the proportion of high burnout was 4.7％.When taking demographic variables into consideration,more introvert and neuroticism indicated increasing tendency of emotional exhaustion.More psychoticism,neuroticism and negative coping style indicated increasing tendency of depersonalization and more introvert and negative coping style indicated increasing of reduced personal accomplishment.Coping style could partly mediate the relationship between personality and job burnout.Conclusion Chinese clinicians suffer from burnout severely,coping styles mediate between the personality factors and the burnout level.

Medium-chain triglycerides(MCT) is one kind of saturated fat,which not only has the same characteristics to the long-chain triglycerides(LCT),but also has its special features.This article reviews the metabolism of MCT,its metabolic influences on the energy and other nutrients,and the progress in clinical use in recent ten years.

The goal of radiologic intervention in patients with membranous or segmental ob struction of inferior vena cava(Budd-Chiari Syndrome)is to relieve the major venous obstruction, control portal hypertension and prevent further hepatocellular damage until collateral hepatic venous outflow channels can develop.Percutaneous balloon angioplasty(PTA)was used to treat 15 patients with this syndrome who were followed up for an average of 30.57?13.57 months(range,8～48 months).In occlusion,PTA can be considered a safe and effective treatment at least patency of one hepatic vein.The therapy is not definitive,multiple treatment are required for the long-term care of the ptients who all hepatic vein are obliterated.

Objective: To evaluate the clinical results of cryopreserved homografts for the treatment of complex congenital heart defects. Methods: In 420 patients with complex congenital heart diseases received surgical correction with right ventricular outflow tract (RVOT) reconstruction was done using cryopreserved homografts. Of the 420 homografts, 234 were aortic homografts and 186 were pulmonary homografts. The mean age of patients was 4.6 years (range, 5 months to 21 years). The mean body weight was 17.5 kg (range, 5.5～52 kg). The mean follow-up time was 27.8 months (range, 3 months to 12.9 years). Results: There were 19 operative deaths with a mortality rate of 4.5%. The postoperative complications occurred in 25 patients and they all recovered uneventfully. The postoperative mechanical ventilation time was 48.7±42.5 hours (range, 8～192 hours). The mean hospital stay was (12.2±9.0) days (range, 7～46 days). There were no late death and complication. Conclusion: The results of this study suggest that ROVT reconstruction with cryopreserved homografts as transannular patch can be achieved with excellent the clinical outcome.

Objective To explore and analyze the clinical curative effect and prognosis of enteric -coated aspirin combined with clopidogrel in the treatment of unstable angina pectoris of coronary heart disease.Methods 84 patients with unstable coronary heart disease angina pectoris were selected in the research,and they were divided into regular treatment group and combination group,42 cases in each group.The patients in conventional treatment group were given enteric -coated aspirin therapy,and the combined treatment group were given clopidogrel on the basis of routine treatment.The myocardial enzymology indexes of 24h before and after drug treatment,electrocardio-gram (ECG)recovery,curative effect and adverse reaction were compared between the two groups.Results After treatment,the myocardial enzymology indexes of the combined treatment group (AST,CK -MB,cTnT,cTnI)had sig-nificant differences compared with the general treatment group (t =3.98,P <0.05,t =0.05,P <0.05,t =0.05,P <0.05,t =0.05,P <0.05).After treatment,the ECG total recovery rate of the combination group increased obviously compared with the conventional treatment group,the difference between the two groups was significant (χ2 =5.49, P <0.05).The total effective rate of the combined treatment group increased obviously compared with the conventional treatment group,the difference between the two groups was significant (90.5% vs 64.3%,χ2 =4.48,P <0.05).The incidence rate of adverse reactions had no obvious difference between the two groups (83.3% vs 66.7%,χ2 =2.88, P >0.05).Conclusion Drug combination therapy in the treatment of unstable type of coronary heart disease angina pectoris can synergistically improve clinical symptoms and physical fitness,improve patients'quality of life,it is safe and reliable,which is worth popularization and application widely.

Objective: To observe the clinical effects of tuina therapy for cervicogenic headache. Methods: Fifty-four cases were randomized allocated into tuina group and medicine group, 27 cases in each group. The patients in the tuina group treated with tuina therapy, and the patients in the medicine group take ibuprofen orally. The headache degree (Visual Analogue Scale, VAS), frequency of headache occurrence and the neck disability index (NDI) were compared 2 weeks pre-treatment and 2 weeks post-treatment. Results: Before treatment, there were no significant differences in the headache VAS, frequency and NDI between the two groups. After treatment, headache VAS, frequency and NDI were significantly decreased, and there were statistical differences between the tuina group and the medicine group (P<0.01). Conclusion: Tuina therapy is more effective for treating cervicogenic headache than routine dose of ibuprofen.