2014年 · 第127卷第15期

Abstract：Background Anterior cruciate ligament reconstruction (ACLR) has developed dramatically in the last century.Now,ACLR has become a reliable and productive procedure.Patients feel satisfied in ＞90％ cases.The aim of this study was to evaluate the feasibility of allogenetic cortical bone cross-pin (ACBCP) used as a clinical fixation method in anterior cruciate ligament reconstruction on the femoral side based on biomechanical tests in vitro.Methods The specimens were provided by the bone banks of the First Affiliated Hospital of People's Liberation Army of General Hospital from September 2011 to June 2012.Fresh deep frozen human allogenetic cortical bone was machined into cross-pins which is 4.0 mm in diameter and 75.0 mm in length.Biomechanical parameters compared with Rigidfix were collected while cross-pins were tested in double-shear test.The load-to-failure test and cycling test were carried out in a goat model to reconstruct anterior cruciate ligament with Achilles tendon autograft on the femoral side fixed by human 4.0 mm ACBCP and 3.3 mm Rigidfix served as control.Maximum failure load,yield load,and stiffness of fixation in single load-to-failure test were compared between the two groups.Cycle-specific stiffness and displacement at cycles 1,30,200,400,and 1 000 were also compared in between.Results In double-shear test both maximum failed load and yield load of 4.0 mm humanACBCP were (1 236.998±201.940) N.Maximum failed load and yield load of Rigidfix were (807.929±110.511) N and (592.483±58.821) N.The differences of maximum failed load and yield load were significant between ACBCP and Rigidfix,P ＜0.05.The shear strength of ACBCP and Rigidfix were (49.243±8.039) MPa and (34.637±3.439) MPa,respectively,P ＜0.05.In the load-to-failure test ex vivo,yield load and maximum failed load of ACBCP fixation complexity ((867.104±132.856)N,(1 032.243±196.281) N) were higher than those of Rigidfix ((640.935±42.836) N,(800.568±64.890) N,P ＜0.05).However,stiffness did not differ significantly between ACBCP group ((247.116±31.897)N/mm) and Rigidfix group ((220.413±51.332) N/mm,P ＞0.05).In the cycling test,the cycle-specific stiffness and displacement at cycles 1,30,200,400,and 1 000 did not differ significantly between the ACBCP group and Rigidfix group,P ＞0.05.Conclusions Allogenetic cortical bone cross-pin possesses satisfactory biomechanical profile which is safe for ACLR and suitable for an aggressive rehabilitation program.Animal and clinical tests should be recommended before clinical use to secure the ACBCP could successfully substituted by host new bone in vivo。

Abstract：Background Severe sepsis and septic shock are the leading causes of morbidity and mortality in hospitalized patients.This study aimed to investigate the association of poly(ADP-ribose) polymerase-1 (PARP-1) activity in circulating mononuclear cells with myocardial dysfunction in patients with septic shock.Methods A total of 64 patients with septic shock were divided into the survival group (n=41) and the nonsurvival group (n=23) according to mortality at 28 days after enrollments.PARP-1 activity in circulating mononuclear cells,brain natriuretic peptide,Acute Physiology and Chronic Health Evaluation Ⅱ score,the cardiac index (CI),the cardiac function index (CFI),global ejection fraction (GEF),and the left ventricular contractility index (dp/dt max) were measured after admission to the intensive care unit.Results PARP-1 activity in circulating mononuclear cells of nonsurvival patients with septic shock was significantly higher than that in survival patients.PARP-1 activity in circulating mononuclear cells was strongly,negatively correlated with the CI,the CFI,GEE and dp/dt max.Multiple Logistic regression analysis showed that PARP-1 activity in circulating mononuclear cells was an independent risk factor of myocardial dysfunction.The optimal cutoff point of PARP-1 activity for predicting 28-day mortality was 942 nmol/L with a sensibility of 78.2％ and specificity of 65.1％.Conclusion PARP-1 activity in circulating mononuclear cells is significantly associated with myocardial dysfunction and may have prognostic value in patients with septic shock。

Abstract：Background Traditional Chinese medical treatment of primary Sj(o)gren's syndrome has advantages over Western medicine in terms of fewer side effects and improved patient conditions.This study was a multicenter,randomized,doubleblind,placebo-controlled clinical trial of the efficacy and safety of ShengJinRunZaoYangXue granules for the treatment of primary Sj(o)gren's syndrome,including the symptoms of dry mouth and dry eye.Methods We undertook a 6-week,double-blind,randomized trial involving 240 patients with primary Sj(o)gren's syndrome at five centers in East China.A computer-generated randomization schedule assigned patients at a 2∶1 ratio to receive either ShengJinRunZaoYangXue granules or placebo once daily.Patients and investigators were blinded to treatment allocation.The primary endpoints were the salivary flow rate,Schirmer test results,and sugar test results.Intention-to-treat and per-protocol analyses were performed.Results All 240 patients were randomly allocated to either the treatment group (n=160,ShengJinRunZaoYangXue granules) or placebo group (n=80) and were included in the intention-to-treat analysis.After program violation and loss to follow-up,a total of 199 patients were included in the per-protocol analysis.At six week,intention-to-treat and per-protocol analyses of the left-eye Schirmer I test results showed an improved difference of 1.36 mm/5 min (95％ CI:0.03 to 2.69 mm/5 min) and 1.35 mm/5 min (95％ CI:0.04 to 2.73 mm/5 min),respectively,and those of the right-eye Schirmer I test results showed an improved difference of 1.12 mm/5 min (95％ CI:0.02 to 2.22 mm/5 min) and 1.12 mm/5 min (95％ CI:-0.02 to 2.27 mm/5 min),respectively.There was no significant difference between the two groups before treatment.After treatment,the between-group and within-group before-and-after paired comparison results were statistically significant (P ＜0.05).Intention-to-treat and per-protocol analyses showed an improved salivary flow rate by 0.04 ml/15 min (95％ CI:-0.49 to 0.58 ml/15 min) and 0.04 ml/15 min (95％ CI:-0.52 to 0.60 ml/15 min),respectively,but the differences were not significant.Intention-to-treat and per-protocol analyses showed that the sugar test results were improved by 1.77 minutes (95％ CI:0.11 to 3.44 minutes) and 1.84 minutes (95％ CI:0.12 to 3.55 minutes),respectively,but the differences were not significant.For the secondary endpoint,intention-to-treat and per-protocol analyses showed significant improvement in the integrated evaluation of treated patients with dry eye and dry mouth after six weeks of treatment.The incidence of adverse events was 15.6％ in the treatment group and 10.0％ in the placebo group.Most (94％) adverse events were mild to moderate in the two groups,and only two cases of serious adverse events occurred in the treatment group; both were caused by autoimmune liver disease.Conclusions Six-week treatment with ShengJinRunZaoYangXue granules for primary Sj(o)gren's syndrome in this large-scale study improved the symptoms of dry mouth,dry eyes,and low tear flow rate with minimal adverse events。

Abstract：Background Cardiac resynchronization therapy (CRT) on patients with advanced and refractory heart failure has made remarkable progress.Clinically,notched QRS (nQRS) is commonly seen on electrocardiographs (ECGs) with bundle branch block morphology and on paced ECGs after implantation of a CRT device,which may reflect the heterogeneity of ventricular myocardial depolarization and electrical activity.The aim of this study was to determine whether patients with more nQRS myocardial segments on paced ECGs had a worse response to CRT than patients with fewer nQRS myocardial segments.Methods We prospectively enrolled 56 patients of CRT with chronic heart failure from People's Hospital affiliated to Peking University from January 2007 to October 2013.Based on nQRS segments on ECGs before CRT,we allocated them to two groups:fewer nQRS (＜2) myocardial segments (lateral,inferior,anterior segments) group (F-nQRS,G1,n=23) and more nQRS (≥2) myocardial segments group (M-nQRS,G2,n=33).Then according to nQRS segments on ECGs after CRT,we divided them into two groups similarly:fewer nQRS (＜2) myocardial segments group (G3,n=24) and more nQRS (≥2) myocardial segments group (G4,n=32).This study was approved by the ethics committee of People's Hospital.Results At 6 months in the baseline-ECG group,there was a greater absolute increase in left ventricular ejection fraction (LVEF) in G2 than in G1 ((11.5±8.9)％ vs.(5.5±10.4)％,P=0.023),with the incidence of nonresponse lower in G2than in G1 (9.1％ vs.39.1％,P=0.018).In the paced-ECG group,the absolute increase in LVEF was less in G4 than in G3 ((6.4±8.8)％ vs.(12.5±10.4)％,P=0.024) and the incidence of nonresponse was higher in G4 than in G3 (31.3％ vs.8.3％,P=0.039).Multivariate analysis showed that fewer nQRS (＜2) myocardial segments on paced ECGs (odds ratio 13.920) was a predictor of positive response to CRT.Conclusion nQRS ≥2 myocardial segments (lateral,inferior,anterior) on paced ECGs may predict a poor response to CRT。

Abstract：Backgroud Misdiagnosis and missed diagnosis of septic pulmonary embolism (SPE),a rare disease,occurs among the patients with right heart infective endocarditis.The purpose of this study was to analyze the characteristics of SPE and improve the early diagnosis and treatment.Methods We retrospectively studied 34 patients with septic pulmonary embolism caused by right-sided infective endocarditis who were seen from June 1,2002 to June 1,2013.We reviewed the medical records and radiological images of these cases and extracted the following information:age,gender,and symptoms,physical examination,laboratory findings,transthoracic echocardiography (TTE) results,treatment information,comorbid medical conditions,and outcomes.Microbiological samples were collected and processed according to well-established and published guidelines.Results We identified basic heart disease in 97.1％ of the patients.A high proportion of the right-sided infective endocarditis patients had congenital heart defects (82.4％); predominantly,ventricular septal defects.Clinical symptoms were fever (97.1％),cardiac murmurs (94.1％) and fatigue (88.2％).Respiratory symptoms included cough (58.8％),pleuritic chest pain (47.1％) and hyoxemia (52.9％).Positive blood cultures were grown from 35.2％ of patients and 50.0％ were caused by staphylococcal species.Chest X-rays or CT examinations detected patchy infiltrates and/or nodules in all cases.Transthoracic echocardiography demonstrated infectious foci of the right-side heart in all cases.Parenteral antibiotics were administered for all,and cardiac surgery was carried out for 76.5％ of patients with an effective rate of 82.3％.Conclusions SPE lacks characteristic clinical manifestation.Congenital heart disease is a common risk of SPE.Most patients with SPE have a good prognosis as long as early diagnosis and proper treatment can be provided。

Abstract：Background Osteoporosis and vertebral factures are well recognized features in patients with ankylosing spondylitis (AS).The aim of this study was to investigate the prevalence and risk factors of osteoporosis and vertebral fractures in patients with AS.Methods Fifty-nine AS patients and 40 healthy controls were enrolled.Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DEXA) at posterior-anterior (PA) lumbar,lateral lumbar and hip regions.Thoracic and lumbar X-rays were obtained for morphometric measurements.Clinical,biological and radiological statuses were evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI),Bath Ankylosing Spondylitis Metrology Index (BASMI),Bath Ankylosing Spondylitis Functional Index (BASFI),Bath Ankylosing Spondylitis Radiology Index-total (BASRI-t),erythrocyte sedimentation rate (ESR) and the C-reactive protein levels.Results Osteoporosis was present in 32％ of patients and 5％ of controls according to lateral vertebral BMD measurements.Fracture was present in 31％ of patients.The effect of some clinical and laboratory parameters on BMD status and vertebral fractures was analyzed in the patient group.Osteoporosis in lateral lumbar DEXA was associated with higher BASMI,BASFI,BASRI-t scores and ESR level.Low hip BMD was associated with low BMI and high BASFI and BASRI-t scores.Vertebral fractures were associated with advanced age,longer disease duration,longer duration since diagnosis,higher BASMI and BASRI-t scores,higher ESR level,reduced femoral and lateral lumbar BMD.Logistic regression analysis revealed that only BASRI-t score was significantly associated with low lateral spinal BMD and BMI and BASFI score were independently associated with low hip BMD.The presence of compression fractures was independently associated with BASRI-t score and low lateral lumbar BMD.Conclusions Osteoporosis and vertebral fractures in AS seem to be related to the extent of radiological involvement.A low lateral lumbar BMD is an important risk factor for vertebral fractures。

Abstract：Background Diversity of orthopedic infections with various local environments affects the pattern and prevalence of pathogens.It is not well-characterized whether different pathogens have different propensity to cause different types of orthopedic infections.We aimed to investigate the frequency of different pathogens derived from orthopedic infections,and determine the relationship between the prevalence of clinical isolates and the type of orthopedic implants,especially focusing on staphylococci.Methods From January 2006 to December 2011,orthopedic infections were identified retrospectively from clinical microbiology laboratory and orthopedic medical records.The sources of orthopedic infections were divided into two main groups:those associated with implants and those not associated with implants.Implants-associated infections were further subdivided into five subgroups:arthroplasty,internal fixation,external fixation,internal and external fixation,and others.We analyzed microbiological spectrum in different groups and subgroups.Antibiotic susceptibility of staphylococci was analyzed.Results Only coagulase-negative staphylococci (CoNS) was significantly more likely to be associated with implantsassociated infections (P=0.029).The overall pathogens prevalence of arthroplasty was significantly different from other subgroups (P ＜0.05).65％ isolates from external fixation was Gram-negative bacteria.Some percentage (55％) of S.aureus and (83％) CoNS were resistant to methicillin.No resistance to glycopeptide was seen in all of staphylococci.Conclusions Staphylococcus aureus was the most frequent isolates in orthopedic infections but was not associated with the presence or absence of implants.Only CoNS was implants-associated,especially for arthroplasty infection.Cefazolin alone is not enough for orthopedic surgery prophylaxis in settings with a high prevalence of methicillin-resistant staphylococci。

Abstract：Background Chordomas of the upper cervical spine are rare and present unique surgical challenge.This study aimed to describe the clinical characteristics and surgical management of patients with chordomas of the upper cervical spine.Methods Twenty-one patients with chordomas of the upper cervical spine who were treated in Peking University Third Hospital from January 1999 to October 2012 were retrospectively analyzed.Survival was calculated by the Kaplan-Meier method and was compared between groups using the log-rank test.Results The postoperative diagnosis was classical chordoma in 20 cases and chondroid chordoma in one case.The mean operative time was 9.5 hours (range 6-17 hours),and the mean blood loss was 2 812 ml (range 700-4 800 ml).There were two postoperative deaths.Unilateral vertebral artery ligation was performed in six patients,cervical nerve roots were cut in six patients,and the external branch of the superior laryngeal nerve was repaired after being cut in one case.Two patients developed postoperative velopharyngeal incompetence,and loosening of the occipitocervical screws was observed in one patient.The recurrence rate was 66.7％ (10/15) after a mean follow-up period of 46.8 months (range 14-150 months).The 5-and 10-year overall survival rates were (39.8±13.1)％ and (31.9±12.7)％,respectively.There was a significant difference in survival rate between patients who underwent surgery and those who did not.Conclusion In spite of the high rates of recurrence and complications after surgical treatment of chordomas of the upper cervical spine,intralesional resection combined with adjuvant radiotherapy remains the optimal treatment to prolong survival。

Abstract：Background Primary systemic light chain amyloidosis (AL) is a rare plasma cell disease,our purpose was to analyze the immunophenotypic characteristics of the plasma cells in bone marrow in AL patients,and explore whether the detection of abnormal plasma cell clones in bone marrow by flow cytometry (FCM) could be used as an important indicator of AL diagnosis.Methods Fresh bone marrow samples were collected from 51 AL,21 multiple myeloma (MM),and 5 Waldenstr(o)m's macroglobulinemia (WM) patients.The immunophenotype of bone marrow cells were analyzed and compared by FCM using a panel of antibodies including CD45,CD38,CD138,CD117,CD56,and CD19.Results In AL,light chain restriction could be identified in 31 cases (60.9％),in which the λ light chain restriction was found in 24 cases (77.4％).In MM,κ light chain restriction was found in 13 cases (61.9％),and λ light chain restriction in eight cases.CD45 on abnormal plasma cells was negative to weakly positive in both AL and MM,but was positive to strongly positive in WM.In the bone marrow plasma cells of the 51 AL,78.4％ were CD56+,68.6％ were CD117+,and 88.2％ were CD19-.While in the 21 MM cases,66.7％ were CD56+,38.1％ were CD117+,and 90.4％ were CD19-.The plasmacytoid lymphocytes in the five WM patients were CD19+ and CD56-,CD117-.Conclusion Detection of abnormal plasma cell clones in bone marrow by FCM is valuable for the diagnosis of AL。

Abstract：Background Post-traumatic stress disorder (PTSD) is a mental disorder with delayed or chronic onset caused by unusual,threatening,or disastrous psychological trauma,and it is an important manifestation of post-disaster mental and behavioral disorders.Studies have shown that IL-6 is a cytokine associated with PTSD occurrence.This study aimed to explore the role of cytokine and ethnicity in the pathogenesis of PTSD by examining levels of serum cytokines IL-2,IL-6,IL-8,TNF-α,and cortisol in PTSD patients of Li and Han ethnic groups.Methods Levels of serum cytokines IL-2,IL-6,IL-8,TNF-α,and cortisol were examined by enzyme-linked immunoabsorbent assay (ELISA) method and assessed by PCL-C scale among 30 PTSD patients of Han ethnicity and 30 of Li ethnicity,and compared with 30 normal controls of Han and Li ethnicity,respectively.Results PTSD patients of Li ethnicity scored higher than PTSD patients of Han ethnicity,and normal controls of Li and Han ethnic groups in each of the re-experiencing,avoidance/numbing,and hyperarousal symptoms.The differences reached statistical significance (P ＜0.05).In PTSD patients of Li ethnicity compared to patients of Han ethnicity and normal controls of either Li or Han ethnicity,the levels of IL-2,IL-6,IL-8,and TNF-α were higher,and the level of cortisol was lower.Conclusions There are ethnic differences in re-experiencing,avoidance/numbing,and hyperarousal symptoms among PTSD patients.The levels of serum cortisol and cytokines are strongly associated with the race。

Abstract：Background Previous epidemiological studies have consistently found a positive family history of esophageal cancer is associated with a significantly increased risk of the cancer.However,whether the elevated risk could be attributed to common household exposure or inherited susceptibility is uncertain.This study aimed to highlight the effect of genetic predisposition by noting the significant differences in onset age and multiple primary cancers between esophageal squamous cell carcinoma (ESCC) cases with or without a positive family history of the cancer.Methods Age at onset and the percentage of multiple primary cancers were compared between ESCCs with (n=766) or without (n=1 776) a positive family history of the cancer in a consecutive surgery cohort at the Department of Thoracic Surgery of Hebei Tumor Hospital and the Fourth Hospital of Hebei Medical University.Results Overall,ESCCs with a positive family history of the cancer featured both a significantly younger age of onset and significantly more multiple primary cancers than those with a negative family history (onset age 51.83 vs.53.49 years old,P ＜0.01; percent of multiple primary cancers 5.50％ vs.1.70％,x2=25.42,P ＜0.01).Both the differences were evident in subgroup analyses,but did not correlate.While age at onset differed significantly by family history among the male,smoking,and drinking groups,the difference of multiple primary cancers was significant among the otherwise nonsmoking,nondrinking,and younger onset age groups.Conclusions Younger age of onset and multiple primary cancers associated with ESCCs with a positive,as opposed to a negative family history of the cancer,suggest a genetic predisposition.The results of subgroup analyses indicate a younger age of ESCC development results from the interaction of environmental and genetic risk factors,but multiple primary cancers may be related only to genetic predisposition。

Abstract：Background The bacterial endotoxins test (BET) is a method used to detect or quantify endotoxins (lipo-polysaccharide,LPS) and is widely used in the quality control of parenteral medicines/vaccines and clinical dialysis fluid.It is also used in the diagnosis of endotoxemia and in detection of environment air quality control.Although BET has been adopted by most pharmacopoeias,result judgment algorithms (RJAs) of the test for interfering factors in the BET still differ between certain pharmacopoeias.We have evaluated RJAs of the test for interfering factors for the revision of BET described in the Chinese Pharmacopoeia 2010 (CHP2010).Methods Original data from 1 748 samples were judged by RJAs of the Chinese Pharmacopoeia 2010,the Japanese Pharmacopoeia 2011 (JP2011),the European Pharmacopoeia 7.0 (EP7.0),the United States Pharmacopoeia 36 (USP36),and the Indian Pharmacopoeia 2010 (IP2010),respectively.A SAS software package was used in the statistical analysis.Results The results using CHP2010 and USP36,JP2011,EP7.0,and IP2010 had no significant difference (P=-0.7740).The results using CHP2010 of 1 748 samples showed that 132 samples (7.6％) required an additional step; nevertheless there was no such requirement when using the other pharmacopeias.The kappa value of two RJAs (CHP2010 and EP7.0) was 0.6900 (0.6297-0.7504) indicating that the CHP2010 and other pharmacopoeias have good consistency.Conclusions The results using CHP2010 and USP36,JP2011,EP7.0,and IP2010 have different characteristics.CHP2010 method shows a good performance in Specificity,mistake diagnostic rate,agreement rate,predictive value for suspicious rate,and predictive value for passed rate.The CHP2010 method only had disadvantages in sensitivity compared with other pharmacopeias.We suggest that the Chinese pharmacopoeia interference test be revised in accordance with the USP36,JP2011,EP7.0,and IP2010 judgment model。

Abstract：Background Several small sample-size observational studies evaluated the association of plasma brain natriuretic peptide (BNP) or N-terminal pro-brain natriuretic peptide (NT-proBNP) with atrial fibrillation (AF),but the results were contradictory.We aimed to perform a meta-analysis of relevant studies to evaluate the availability of this association.Methods We performed an extensive literature search on PubMed,Web of Science (WOS) and the Cochrane Library databases.Pooled standardized mean difference (SMD) and 95％ confidence interval (CI) were calculated to assess the strength of association using random effects models.We performed sensitivity and subgroup analyses to explore the potential sources of heterogeneity.We also estimated publication biases.Statistical analyses were performed using the STATA 12.0 software.Results A total of 11 studies including 777 cases and 870 controls were finally analyzed.Overall,the brain natriuretic peptide/N-terminal pro-brain natriuretic peptide levels were higher in atrial fibrillation patients than controls without atrial fibrillation.Results showed that the SMD in the natriuretic peptide levels between cases and controls was 2.68 units (95％CI 1.76 to 3.60); test for overall effect z-score=5.7 (P ＜0.001).There was significant heterogeneity between individual studies (I2=97.8％; P ＜0.001).Further analysis revealed that differences in the assay of natriuretic peptide possibly account for this heterogeneity.Conclusions Increased BNP/NT-proBNP levels were associated with the presence of atrial fibrillation.This finding indicates that BNP/NT-proBNP may prove to be a biomarker of an underlying predisposition to AF。

Abstract：Background Our goal was to evaluate the outcomes of kidney transplants from controlled cardiac death donors compared with brain death donors by conducting a meta-analysis of cohort studies.Methods The PubMed database and EMBASE were searched from January 1980 to July 2013 to identify studies that met pre-stated inclusion criteria.Reference lists of retrieved articles were also reviewed.Two authors independently extracted information on the designs of the studies,the characteristics of the study participants,and outcome assessments.Results Nine cohort studies involving 84 398 participants were included in this meta-analysis; 3 014 received kidneys from controlled cardiac death donors and 80 684 from brain death donors.Warm ischemia time was significantly longer for the controlled cardiac death donor group.The incidence of delayed graft function was 2.74 times (P ＜0.001) greater in the controlled cardiac death donor group.The results are in favor of the brain death donor group on short-term patient and graft survival while this difference became nonsignificant at mid-term and long term.Sensitivity analysis yielded similar results.No evidence of publication bias was observed.Conclusion This meta-analysis of retrospective cohort studies suggests that the outcome after controlled cardiac death donors is comparable with that obtained using kidneys from brain death donors。

Abstract：Background Several studies found that vitamin D3 might alter glucose metabolism,protect kidney from injury and even proposed the mechanisms.But results from previous studies have been conflicting.The aim of this study was to evaluate the efficacy and safety of vitamin D3 in patients with diabetic nephropathy.The underlying mechanism of vitamin D3 decreasing proteinuria is also discussed.Methods We conducted a search of English and Chinese articles using database of Pubmed,Embase,Sinomed,CNKI,Wanfang and clinical trial register centers,for randomized controlled trials of vitamin D3 in diabetic nephropathy patients.Two reviewers performed independently.Meta-analysis was used when studies were homogeneous enough.Results Twenty studies,including 1 497 patients with diabetic nephropathy,were involved in this systemic review.Vitamin D3-treated patients with diabetic nephropathy had a statistically significant reduction in 24-hour proteinuria (weighted mean difference-0.44,95％ CI-0.54 to-0.34,Z=8.80,P ＜0.000 01) and urine albumin/creatine ratio (standardized mean difference-0.29,95％ CI-0.48 to-0.10,Z=2.96,P=0.003).But vitamin D3 supplementation did not significantly reduce blood pressure and hemoglobin A1c compared with control group.The potential mechanisms about the renal protection of vitamin D3,including the inhibition of rennin-angiotensin system,the protection of kidney from inflammation,fibrosis and the structure change of kidney are discussed.In addition,vitamin D3 did not significantly increase the incidence of adverse effects,including total adverse effects,gastrointestinal adverse effects and fluctuation of blood pressure.Conclusions Vitamin D3 can ameliorate proteinuria and protect kidney from injury in patients with diabetic nephropathy.This renoprotective effect is independent of blood pressure and glucose reduction.And it does not increase any adverse effects than control,even in combination therapy with angiotensin converting enzyme inhibitors/angiotensin receptor blockers.But due to the limited randomized controlled trials of high quality,more clinical researches should be taken in the future。

Abstract：Background By synthesizing results from primary studies,systematic review can provide empirical information of concerned problems.This study aimed to review the available surveillance data from studies reporting the contamination surveillance of food lead in China.Methods Relevant studies were identified by systematically searching Chinese Biological Medicine Database and China National Knowledge Infrastructure using the key term of "lead" for surveillance data published in Chinese between 2006 and 2012.To avoid potential selection bias,all articles were evaluated by two independent reviewers,and the disagreements were resolved by discussion or the third author was asked to arbitrate.Results Among 269 identified publications on surveillance data of lead in food,43 articles met the defined inclusion criteria.The food samples were divided into 11 groups (cereal grains and pulses,fish,eggs,vegetables,meat,edible fungi,milk and dairy products,fruits,offal,tea and preserved egg).Surveillance data of publications were reviewed to calculate the weighted mean and rate exceeding maximum levels.Our results indicated that the highest lead concentration was 1.937 mg/kg in tea.The total pementage of samples exceeding the maximum levels was 5.57％.Dietary exposure to lead was assessed by combining the weighted mean concentration of surveillance data with national consumption data in 2002.In this review,dietary intake of lead was 1.232 μg/kg b.w./day.Conclusion Further control measures should be taken to reduce exposure to lead,from both dietary and non-dietary sources。

Abstract：Objective To review the experimental drugs for the treatment of autoimmune myocarditis.Data sources The literatures published in English about different kinds of experimental drugs based on different therapeutic mechanisms for the treatment of autoimmune myocarditis were obtained from PubMed from 2002 to 2013.Study selection Original articles regarding the experimental drugs for treatment of autoimmune myocarditis were selected.Results This study summarized the effects of the experimental drugs for the treatment of autoimmune myocarditis,such as immunomodulators and immunosuppressants,antibiotics,Chinese medicinal herbs,cardiovascular diseases treatment drugs,etc.These drugs can significantly attenuate autoimmune myocarditis-induced inflammation and fibrosis,alleviate autoimmune myocarditis-triggered overt lymphocyte proliferation,and meanwhile reduce Th1 cytokines (IFN-γ and IL-2) and increase Th2 cytokines (IL-4 and IL-10).Conclusion This study summarized recent advances in autoimmune myocarditis treatment and further proposes that traditional Chinese medicine and immune regulators will play important roles in the future。

Medical technologies refers to the measures taken for the purpose of diagnosing and curing diseases,alleviating illnesses,reducing the pain,as well as helping patients restore health and prolonging their lives.According to the regulation on the clinical application of medical technology published by the Ministry of Health in 2009,medical technologies are divided into three classes according to their safety and effectiveness.Comparing with second and third class medical technologies,first class medical technologies are more accurate in their safety and validity.1 Now that the Ministry of Health had made clear requirements for the management of the second and third class technologies,the first class technologies still lack specific standards for their admission as well as development management.2。

Laparoscopic nephrectomy (LN) is a less invasive surgical option for patients with renal disease.However,it may be complicated with disastrous CO2 embolism,which is rare but a life-threatening consequence.Here,we present a case of lethal CO2 embolism during LN.Fortunately,the complication was detected early and managed successfully.Our case and literature review all revealed that gas embolism must be considered as a possible cause of sudden cardiocirculatory failure during LN;rapid diagnosis and definitive intervention can decrease fatality from such an injury.Possible mechanisms of CO2 embolism and the potential ways of handling such an event are also discussed。

Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is associated with neuromuscluar complications in fewer than 5％ of patients.1 The most common causes are associated with the toxicity of the conditioning regimen,infections,bleeding,and malignant disease relapse.Allo-HSCT related neuromuscular complications can also be caused by immune-mediated mechanisms,which are usually present in the form of myositis/polymyositis or demyelinating polyneuropathy。

Fewer than 300 patients with primary pulmonary artery sarcoma have been reported since 1923,when it was first described by Mandelstamm.1 The diagnosis of pulmonary artery sarcoma is difficult,and misdiagnosis as chronic pulmonary embolism often occurs.Herein,we reported a case of primary pulmonary artery chondrosarcoma.So far as we know,this patient served as the first case ever reported to receive computed tomography pulmonary angiography (CTPA),gadolinium enhanced magnetic resonance imaging (MRI),and positron emission tomography/computed tomography (PET/CT) before surgery.By these means,the utility of different imaging modalities for pulmonary artery sarcoma was well demonstrated。

With the population aging and an increasing desire for a high quality of life,millions of patients who suffered knee arthropathy have undergone total knee arthroplasty (TKA).Although the success rate for primary TKA has been quite high,the number of revision surgeries can not be ignored.Bone loss is one of the challenges confronting surgeons who perform revision TKAs as it can impair alignment accuracy and the long-term stability of the implant.Although several options are available for bone loss after TKA——cement,bone grafting,standard augments,and hinged implants——there is no single ideal option available for all patients with a severe bone defect because of the variety and severity of the defects.1 The burgeoning rapid prototyping (RP) technique,which has been used to fabricate components with complex and unique structures,may offer a novel option in these cases。

Pulmonary thromboendarterectomy (PEA) is the recommended treatment for chronic thromboembolic pulmonary hypertension (CTEPH).1 Pulmonary artery injury is a major risk factor during PEA performed at less experienced surgical centers and is associated with adverse short-term consequences.In-hospital mortality may be as high as 15％ in some PEA case series,with pulmonary artery injury and persistent pulmonary hypertension as the principal etiologies.2 Many techniques have been used to prevent pulmonary artery injury during PEA,but once the injury occurs,the prognosis is poor and may even result in death.Out of 202 PEA procedures performed at our surgical center,we successfully managed two cases of severe pulmonary artery injury and report our experience in the present case series。

Choroidal hemangiomas (CHs) are relatively rare,benign,vascular,hamartomatous tumors.They are categorized to circumscribed choroidal hemangiomas (CCHs) or diffuse choroidal hemangiomas (DCHs) clinically and histologically.Although circumscribed CHs (CCHs) are often asymptomatic,they can affect visual acuity (VA) if they are situated beneath the fovea,where they can cause accumulation of secondary subretinal fluid and/or cystic retinal degeneration.Due to its minimal invasiveness and negligible toxicity to the normal retina,photodynamic therapy (PDT) with verteporfin has been applied widely in the treatment of CCH.1 Treatment strategies for CCHs should take into account tumor size,anatomic location,VA,and presence/absence of complications.The present study was conducted to identify potential predictors of successful PDT treatment other than those previously reported.We also present alternative treatment modalities for larger,more complicated CCHs。

To the editor:Conjoined twinning is a rare congenital malformation,which occurs in single chorionic amniotic twins.Most of the twins are dead in embryomc period;thus it is uncommon to surgically separate the conjoined twins successfully and for both to survive.1 It is necessary to improve the perioperative management and increase the survival rate of the separation of thoraco-omphalopagus symmetrically conjoined twins。

To the editor:Fibroadenomas are very common breast benign tumor in women who are in period of reproductive age.Generally speaking,fibroadenomas that measure ＞5 cm in size or exceeding 500g in weight are commonly classified as giant fibroadenomas.When these enlarged masses are found in young female patients,they are often called giant juvenile fibroadenomas.1 Giant juvenile fibroadenomas is very rare in patient with fibroadenomas,especially in underdeveloped breast.Here we report a case of giant juvenile fibroadenoma associated with dysplasia on the underdeveloped breast。

To the editor:Laparoscopic cystectomy and ileal neobladder is a conventional treatment for muscle invasive bladder cancer.Obstruction of ileal loop in urinay diversion surgery is an extremely rare complication.We reported a case of ileal loop obstruction because of angled adhesion after laparoscopic cystectomy and Bricker type urinary diversion。

To the editor:Esophageal leiomyoma is a common esophageal submucosal tumor.Endoscopic ultrasonography (EUS)examination is usually used for diagnosis of the tumor bulge in the cavity.However,the miniature ultrasound probes occasionly make the diagnosis difficult for the presence of vascular malformations caused by extemal pressure.Here,we report a case of a right descending aortic arch deformity misdiagnosed as an esophageal leiomyoma。

To the editor:Kidney foreign body mainly comes from gastraintestinal but not urogenital tract.Herein we report a case of needle in the kidney migrated from urethra.The patient presented with gross hematuria and fever for 1 month.He put an ancupuncture needle and thermometer into the urethra 9 years ago.Imaging examination revealed the needle has already migrated to the right kidney.He received percutaneous nephroscopy and cystoscopy to remove the objects and recovered well.To our knowledge,we present the most amazing phenomenon and challenging surgery to do with this uncommon foreign body in kidney。