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.

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-.

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.

Objective:To evaluate the characteristics and the treatment of nonunion cases of mandibular fractures. Methods:24 patients with 28 sites of nonunion of mandibular fracture were retrospectively investigated. The involvement came from the group of 1087 cases who were treated from 1990 to 2004 in Department of Oral and Maxillofacial, Peking University School of Stomatology. The data were recorded and analyzed. Results:The nonunion rate was 2.2% in present study. Furthermore, mental region and mandibular body were the most common sites of nonunion fracture. 11 patients caused by inadequate fixture were treated only by improving fixation and 9 out of 10 patients in whose nonunion was caused by fracture bone defect were treated by bone grafting. On the other hand, 2 out of 3 patients of nonunion caused by bone infection were treated by curetting the inflammation lesion and bone grafting. 23 patients all healed after 3-6 months postoperatively except 1 patient. Conclusion:The incidence of nonunion is lower than those reported by other researchers outside China. Inadequate fixture, fracture bone defect and bone infection are three causes contributing to nonunion of mandibular fractures. The treatment for nonunion includes improving fixture, curetting the inflammation lesion and bone grafting.

[Objective]To investigate the treatment method and clinical outcome of posterior midline approach and internal fixation with Y-shaped plate for complex distal 2/3 humeral fracture.[Method]From November 2001 to February 2006,33 patients with complex distal 2/3 humeral fracture were treated with posterior midline approach and Y-shaped plate internal fixation.There were 5 females and 28 males,with a mean age of 37.6 years(ranging from 19 to 57 years).According to AO/ASIF classification,type C1 fracture was found in 21 cases,type C2 in 3 cases and type C3 in 9 cases.Seven of these were open fractures(4 cases of Gustilo-Anderson type Ⅰ and 3 cases of type Ⅱ).Measures of auto-ilium transplant(21 cases)and homolegous allograft bone transplant(12 cases)were also taken.The operation was performed at 2.5 hours～7 days after injury with mean 3 days.[Result]Thirty-three patients were followed up for a mean period of 15.6 months(6～28 months).Fractures of 31 patients healed at 19 weeks after the treatment.Delayed union occurred in two patients.The function of the elbow was evaluated according to Morrey's scale,the results showed excellent in 24 cases,good in 7 cases,and poor in 2 cases.At the last follow-up,the muscle strength of elbow extension was about 4～5 grade.[Conclusion]Posterior midline approach and Y-shaped plate internal fixation of complex distal 2/3 of humeral fracture is a safe and effective technique.Protecting the radial nerve and ulnar nerve,prophylactic bone grafting and reasonable postoperative rehabilitation are very important to obtain satisfactory clinical outcome.

The angle of tibial torsion is an inherent angle in human bodies.The angle has been to knew of clinical workers.But the research of mechanism for angle of tibial torsion and relationship with some disease still in initial stage.Recent years,the angle of tibial torsion has been noticed with the concept of torsionaldeform appearance.This paper summarizes measurement of the angle of tibial torsion andits advancement of correlated research.

The treatment for chronic heart failure has been changed significantly in recent 20 years.Therapeutic target in heart failure not only improves symptoms and quality of life,more important is for the mechanism of myocardial remodeling,prevent and delay the development of myocardial remodeling.Angiotensin converting enzyme inhibitor/angiotensin receptor blockers,beta blockers,and aldosterone inhibitors are used as the golden triangle drug therapy for chronic heart failure.In recent years,it has been or is about to carry out some clinical new drugs for the treatment of chronic heart failure.

Objective To evaluate the curative effect ofXuebijing injection combined with routine western medicine therapy in the treatment of hypertensive renal damage.Methods A total of 114 patients with hypertension were randomly divided into 2 groups according to the random number table method, 57 patients in each group. The control group was given conventional treatment (maleic acid enalapril and amlodipine and atorvastatin cutting atorvastatin calcium), and the treatment group were givenXuebijing injection based on the conventional treatment. The two groups were treated for 6 months. The changes of blood pressure, renal function and serum inflammatory cytokine levels were evaluated.Results After treatment, the mean value of 24 h systolic blood pressure, mean value of 24 h diastolic blood pressure, systolic blood pressure variability and diastolic blood pressure variability in the treatment group were significantly lower than those in the control group (2 months after treatment:t values were 5.256, 5.595, 5.265, 2.564,P<0.05; 6 months after treatment:t values were 6.251, 5.267, 4.466, 5.264,P<0.05); the urinary mAlb, beta 2-MG, and urine albumin to creatinine ratio in the treatment group were significantly lower than those in the control group (2 months after treatment:t value were 5.566, 5.282, 2.862,P<0.05; 6 months after treatment:t value were 5.263, 6.565, 3.642,P<0.05);two plasma D-dimer, IL-6, TNF-α and fibrinogen levels in the treatment group were significantly lower than those in the control group (2 months after treatment:t value were 3.565, 5.652, 3.985, 5.251,P<0.05; 6 months after treatment:t value were 5.268, 4.836, 3.622, 4.265,P<0.05).ConclusionsXuebijing injection combined with routine western medicine therapy on hypertensive renal damage may have protective effect, and its curative effect was superior to simple maleic acid enalapril and amlodipine and atorvastatin cutting atorvastatin calcium therapy.

Objective To explore the clinical significance of monitoring the femoral artery hemodynamics of acute cerebral hemorrhage patients under general anesthesia by color doppler ultrasound .Methods Totally 30 patients who received emergency craniotomy for intracra-nial hematoma were performed the induction of general anesthesia and endotracheal intubation .The changes of femoral artery peak systolic ve-locity (Vs),early diastolic reverse peak velocity (Vd),systolic diameter (Ds),diastolic diameter (Dd),systolic blood pressure(SBP),dias-tolic blood pressure ( DBP) ,mean arterial pressure ( MAP) and heart rate ( HR) at each time point of before and after anesthesia induction , intubation,cutting the endocranium ,suturing the flaps were observed and recorded .Results Compared with those before anesthesia induc-tion,the MAP,VD and Vs were decreased (P<0.05),DS and DD increased (P<0.05) at each time point.Compared with those after anes-thesia induction,MAP and VD increased,VS reduced(P<0.05) at the intubation moment,the changes of DS and DD was not statistically significant,which compared with those after cutting the endocranium ,MAP,VS and VD decreased,but DS and DD increased (P<0.05).The changes of HR at each time point was not statistically significant (P>0.05).Conclusion Color doppler ultrasound could reflect the femoral artery hemodynamics of patients who subjected to craniotomy for intracranial hematoma under general anesthesia ,which provides some guid-ance for the general anesthesia strategies .

Objective To compare the efficacy of vacuum sealing drainage( VSD) and the traditional treatment for breast abscess drain-age abscess.Methods A total of 59 cases with breast abscess in our hospital from February 2013 to December 2014 were randomly divided into two groups.The observation group underwent VSD and the control group treated by traditional abscess drainage of abscesses.The healing time,scarring length,the average length of hospital stay,number of dressing changes,pain degree were observed.The breast deformation and the recurrence of patients after 6 months were compared.Results The abscess healing time,the length of scar and the average days of hospi-talization were respectively (10.3 ±1.2) d,(1.5 ±0.2) cm,(12.7 ±3.5) d,the control group were respectively (16.5 ±2.6) d,(4.5 ± 0.6) cm,(26.9 ±3.3) d.The difference between two groups was statistically significant(P<0.05).The number of dressing changes and pain score of observation group were respectively (3.9 ±1.1) times and (3.3 ±0.6 ) points,the control group were respectively (10.5 ±1.5) times and (6.7 ±0.9) points.The difference between two groups was significant(P<0.01).All patients were followed up for 6 months,no recurrence was in observation group,and 1 case with recurrence in control group,the difference was not statistically significant(P>0.05).No breast deformation occurred in observation group,but 5 cases in the control group.The difference between two groups was statistically signifi-cant(P<0.05).Conclusion The effect of VSD for breast abscess is significant,which can accelerate the healing of the abscess and reduce the suffering of patients without affecting the appearance.