This review focuses on the fetal origins of adult disease hypothesis put forward by David Barker and his colleagues,recent advances in epidemiological studies and experimental research in this field.Barker Hypothesis states that environmental factors,particularly intrauterine nutrition,as indicated by birth weight,operate in early life to program the risks for adverse health outcomes in adult life.A large growing body of reports described the association between the early development and adult diseases,such as diabetes,hypertension,coronary heart disease,abnormal lipids metabolism,obesity and cancer,etc.Experimental studies show that the changes of some key genes' expression,caused by epigenetic modifications,lead to a permanent alteration of cellular proliferation and differentiation and finally the genesis in key tissues and organs.These results bring about the impairment in structures and functions and the increased susceptibility to chronic diseases in adult life.The hypothesis provides a new perspective for the prevention and therapy of chronic diseases.

In order to study on the theory of " phlegm and blood stasis having same source" and effects of drugs for resolving phlegm on blood rheology, effects of Ban Xia, Gua Lou, Zhe Bei Mu and Shi Chang Pu on whole blood viscosity, erythrocyte deformation index and plasma fibrinogen content in normal rats. Results indicated that the drugs.for resolving phlegm had functions of decreasing whole blood viscosity, inhibiting hemoagglutination (except Gua Lou) and increasing capability of erythrocyte deformation; at high shearing rate, Shi Chang Pu and Zhe Bei Mu could slightly increase whole blood viscosity: Shi Chang Pu increased slightly plasma fibrinogen content. It is suggested that resolving phlegm also can removing blood stasis, and the mechanism of the drug for resolving phlegm in decreasing blood viscosity is related with decrease of blood lipids and anti - peroxidation of lipids.

Objective To evaluate the efficacy and safety of sodium aescinate for abdominal operation in general surgery.Methods A multicenter,prospective and open labeled trail was conducted.Data of 2001 patients in PPS group who had undergone either conventional treated (n =500) or sodium aescinate treated (n =1 501) for abdominal operation in general surgery were analyzed.In the sodium aescinate treated group,sodium aescinate was given by ivgtt 12 h before the surgery started,and 20 mg daily after the surgery for 6 days.Time to recovery of gastrointestinal sounds (TRGS),time to recovery of passage of gas (TRPG),and time to recovery of bowel movements (TRBM) were recorded to evaluate the bowl function recovery.The difference of incision edema was observed by the evaluate edema level.Results The TRGS of sodium aescinate treated group was significantly shorter than that of the conventional treated group,P ＜ 0.01.The TRPG of sodium aescinate treated group was significantly shorter than that of the conventional treated group,P ＜ 0.01.The TRBM of sodium aescinate treated group was significantly shorter than that of the conventional treated group,P ＜ 0.01.The incision edema of sodium aescinate treated group was better than that of conventional treated group.The rate of adverse event was low in the sodium aescinate treated group,phlebitis was the most common one,accounting for 0.66％.No serious adverse event happened.Conclusion Sodium aescinate is effective and safe in accelerating patients recovery in general surgery.

Objective To investigate the causes,diagnosis,treatment of the difficult postoperative decannulation resulting from tracheotomy between children and adults and the method of improving the rate of successful decannulation.Methods Clinical data of 56 cases with difficult decannulation after tracheotomy were analysed retrospectively,all the patients were admitted in our hospital between Jan 1990 and Oct 2006.All the patients were separated into two groups,children group including 24 cases of 14 months ～ 14 years old,adult group including 32 cases of age ranging 15 ～ 48 years old.The postoperative time after tracheotomy were 6 month ～ 1.5 year and 6 month ～ 2 year respectively.Results There were differences of the etiology,diagnostic choice and the clinical manifestation in the treatment of the diffficult decannulation after tracheotomy between children and adults.Children with difficult decannulation after tracheotomy occurred mainly in laryngitis and airway foreign body airway caused by obstruction retrieved after tracheotomy (14/24,58.33 ％),followed by the emergency tracheotomy,such as head and neck trauma (7/24,29.17％).Adults with difficult decannulation after tracheotomy mainly occurred in the throat caused by traumatic lesions of the larynx (including malformations,subglottic stenosis of larynx or vocal cord paralysis) (23/32,71.88％).The average block time in children with anti-inflammatory treatment was significantly lower than that in without anti-inflammatory therapy (6.2 d vs 10.1 d,t =4.26,P ＜ 0.01).However,there was no significant difference in the average block time in adults with anti-inflammatory and without anti-inflammatory treatment (t =1.63,P ＞ 0.05).In the course of treatment,rates of children consciously breathing difficulties (21/21,100％) was also significantly higher than the adult group (13/28,46.43％).Conclusion Children less than 3 years old should avoid tracheotomy.There is no definite relation between the successful treatment in the difficult decannulation and the age of the patients over 3 years old.The first failure treatment in children may be related with the local inflammation.When in treatment,doctors should observe the characteristics of respiratory difficulties,take attention to the influence of children psychological factors to the treatment.Children should be treated in the non-traumatic examination methods.

Objective To investigate the efficacy and safety of laparoscopic radiofrequency ablation (RFA) therapy for hepatocellular carcinoma.Methods Clinical data of 78 hepatocellular carcinoma patients undergoing laparoscopic radiofrequency in Beijing China-Japan Friendship Hospital from May.2008 to July.2010 were reviewed retrospectively.Age ranged from 31 to 87 years,41 were male and 37 were female.Intraoperative ultrasound-guided needle biopsy was performed and diagnosis of hepatocellular carcinoma was established in all cases before RFA was carried out.Data analysis was performed using software SPSS or OriginPro7.Necrosis,local recurrence of the tumor and the cumulative survival rate were analyzed by Kaplan-Meier test and x2 test.Results The median follow-up time was 16 months after RFA treatment.Tumor size,proximity to intrahepatic vessels and combination with TACE were factors that influence local recurrence.The complete ablation (CA) rate was remarkably higher in tumors ＜ 3 cm than in tumors ＞ 3 -5 cm (90.5％ vs 71.4％,x2 =4.291,P =0.038 ).Tumors adjacent to major vessels had a significantly lower CA rate as compared with those not adjacent to them (63.6％ vs 91.9％,x2 =6.351,P =0.012).The CA rate were 88.9％ in the TACE ± RFA group and 75.0％ in the RFA group ( x2 =1.567,P =0.211 ).The mean overall survival were 48.7 ± 2.4 months,the cumulative survival rate was 86.1％ at 1 year、76.9％ at 2 years、60.3％ at 3 years、51.8％ at4 years and 33.1％ at 5 years.Conclusions Laparoscopic RFA is safe,mini-invasive and effective for unresectable hepatic carcinoma with a favorable long term survival.

Objective To analyze the genetic polymorphism of three short tandem repeat (STR) double loci,namely,six STR loci in the Chinese population of Han nationality in Jilin district and to obtain the corresponding genetic data.Methods DNA was extracted from the blood cells of one hundred and three unrelated individuals of Han nationality in Jilin district;Six loci were divided into three groups which were groupⅠ(TPOX+CSF1PO),groupⅡ(D3S1358+D13S317) and groupⅢ(D5S818+D19S400).The extracted DNA were amplified with PCR multiplexing method.The PCR products were analyzed by non-reduced PAGE,followed by silver staining.The allele frequency distributions of six STR loci were studied by statistical procedures.The heterozygosity (H),discrimination power (DP),probability of exclusion (PE) and polymorphic information content (PIC) were calculated.Results The allele frequencies of six loci were obtained.The genotypes distributions of the loci were consistent with Hardy-Weinberg equilibrium and had higher heterozygosities and PIC.The H,DP,PE and PIC were 0.7511-0.8376,0.8273-0.9247,0.5167-0.6718 and 0.7100-0.8195 respectively.Conclusions The three STR double loci exhibited higher polymorphism and were better genetic markers.The data on the allele frequencies of these six STR loci may be used in individual identification,paternity testing and in other population genetic researches.

Sirtuin 1 (SIRT1),the Ⅲ class deacetylation enzyme,is a kind of NAD + dependent histone deacetylation enzyme.The role of SIRT1 in tumor has the duality.It can inhibit inflammation,tumor angiogenesis and interact with tumor related gene to inhibit tumor development.However,it can also regulate tumor related genes,and epithelial-mesenchymal transition,promote tumor cell proliferation and tolerance of radiotherapy and chemotherapy,and maintain the stemness of cancer stem cells to promote tumor proliferation,invasion and metastasis.

Objective To investigate the effect of minitype titanium plate fixation through transoral approach in the treatment of unstable atlas fractures.Methods A retrospective case series study was made on 21 patients with unstable atlas fractures treated by minitype titanium plate fixation through transoral approach from June 2008 to June 2014.There were 15 males and 6 females,at age of (40.9 ± 10.6)years (range,21 to 57 years).Anterior 1/2 Jefferson fractures were seen in 12 patients and 1/2 ring Jefferson fractures in 9 patients.Preoperative visual analogue score (VAS) was 4-9 points [(7.6 ± 1.3) points].Before operation,degree of mobility of the cervical vertebra was (15.4 ± 3.9) °in bending,(10.8 ± 2.5) °in extending,(18.3 ± 3.1) ° in left-bending,(18.9 ± 2.7) ° in right-bending,(21.8 ± 5.8) °in left-rotation and (22.4 ± 4.6) ° in right-rotation.Operation time,intraoperative blood loss,VAS,cervical mobility and bone healing were detected after operation.Results Operation time was (86.3 ±25.3)m in,and intraoperative blood loss was (120.5 ± 33.3)ml.VAS was improved to 0-2 points [(1.6 ± 0.4) points] at postoperative 3 days (P ＜ 0.05).All patients were followed up for 12 to 48 months[(23.7 ±5.9) months].VAS was improved to 0-2 points[(0.6 ± 0.1) points] at postoperative 3 months (P ＜ 0.05).Degree of mobility of the cervical vertebra was improved significantly at postoperative 3 months,with the bending of(38.6 ± 4.5) °,extending of (39.3 ± 4.0) °,left-bending of (39.2 ± 4.0) °,right-bending of (39.2 ± 2.9) °,left-rotation of (66.8 ± 8.8) ° and right-rotation of (66.3 ± 9.2) ° (P ＜ 0.05).Postoperatively,there were no surgical wound incision infections and vertebral artery or spinal injuries,Bone union was found in all patients,without the occurrence of implant loosening or breakage and the dysfunction of the cervical vertebra.Conclusion Minitype titanium plate fixation through transoral approach is associated with less trauma,high healing rate and preservation of the activity of cervical vertebra in the treatment of unstable atlas fractures.

Objective To compare the outcomes of percutaneous pedicle instrumentation combined with vertebral augmentation or vertebra pedicle instrumentation for treatment of osteoporotic thoracolumbar fractures (OVCF) in elderly patients.Methods A retrospective case cohort study was conducted on 62 patients with OVCF manifesting non-neurological symptoms treated from January 2009 to January 2012.There were 22 males and 30 females,with a mean age of 61.3 years (range,55 to 70 years).Fracture level was T11 in 8 patients,T12in 20,L1 in 22 and L2 in 12.Treatments included percutaneous pedicle instrumentation combined with vertebral fracture fixation in 36 patients (Group A) and percutaneous pedicle instrumentation combined with vertebral augmentation in 26 patients (Group B).Operation time,intraoperative blood loss,anterior vertebral body height,sagittal Cobb angle and visual analogue score (VAS) were compared between the two groups.Results All patients were followed up for average 46.5 months (range,36 to 58 months).Operation time in Group A [(82.6 ±16.2) min] was shorter than that in Group B [(96.8 ± 20.6) min] (P ＜ 0.05).Blood loss in Group B [(40.5 ± 10.2) ml] was less than that in Group A [(52.2 ± 15.5) ml] (P ＜ 0.05).Before operation and 3 days and 1 year after operation,the anterior vertebral body height and sagittal Cobb angle in Group A showed no significant differences compared to Group B (all P ＞ 0.05).At the final follow-up,the ratio of anterior vertebral height and Cobb angle in Group B [(87.8 ± 2.5) ％,(7.8 ± 3.5) °] were better than these in Group A [(82.6 ±3.2)％,(9.1 ± 1.8)°] (P＜0.05).VAS showed no statistical significance between the two groups before and after operation (P ＞ 0.05).Bone cement leakage was seen in four patients in Group B.During the perioperative period,there were 3 patients with lung infection in Group A and 1 patient with lower limb deep vein thrombosis in Group B.No implant failure occurred in both groups.Conclusion Both procedures are effective in treating elderly patients with OVCF,but percutaneous pedicle instrumentation combined with vertebral augmentation is associated with better results in maintaining vertebral height and preventing kyphosis.

Objective To prospectively evaluate the sensitivity and specificity of ankle brachial index (ABI) in the diagnosis of lower extremity arterial disease(LEAD)by using conventional digital subtraction angiography (DSA) as the reference standard, and to research the threshold value of ABI screening test for diagnosis. Methods A total of 383 consecutive patients (245 men and 138 women, mean age (64.1±11.7) years] underwent conventional DSA and ABI measurement. Receiver operator characteristics (ROC) analysis was performed to assess possible threshold values for predicting the LEAD in these patients. Results Conventional DSA was used as the gold standard in defining≥50% luminal stenosis for the diagnosis of LEAD. 0. 95 was the overall cutoff of ABI which was associatcd with 93.0% sensitivity, 85.0% specificity, 8.81 positive likelihood ratio(+LR) and 0. 23 negative likelihood ratio(-LR) for detection of hemodynamically significant stenosis (lesions>≥50%) in all 383 subjects (P<0.01). The area under the ROC curve was 0. 953(95%CI 0.920～0.985). Conclusions ABI measurement is an accurate and reliable non-invasive alternative to conventional DSA in the diagnosis of lower extremity arterial disease. And the cut-off 0.95 is the threshold ABI value for detecting LEAD in Chinese population.