2012年 · 第125卷第08期

Abstract：Background Percutaneous transluminal renal angioplasty with stent is an effective procedure for atherosclerotic renal artery stenosis.However,the decision to perform this procedure has recently raised considerable debate.The aim of this study was to assess the effects of percutaneous transluminal renal angioplasty with stent in atherosclerotic renal artery stenosis patients,especially as it relates to blood pressure control and renal function improvement.Methods A retrospective analysis was made of the clinical data from 125 atherosclerotic renal artery stenosis patients who underwent percutaneous transluminal renal angioplasty from July 2004 to June 2008 in the Department of Vascular Surgery of Beijing Chaoyang Hospital.We compared blood pressure,number of oral antihypertensive medications,and renal function changes pre and post-procedure at 24 months follow-up.Results A total of 125 atherosclerotic renal artery stenosis patients underwent percutaneous transluminal renal angioplasty and 143 stents were placed.At 24 months follow-up,both systolic and diastolic blood pressure and the number of oral antihypertensive medications were significantly reduced (P ＜0.05).Overall,the estimated glomerular filtration rate did not change significantly (P ＞0.05); however,a significant increase in estimated glomerular filtration rate was observed in the subgroup of patients with a lower baseline estimated glomerular filtration rate and in the subgroup of patients with bilateral renal artery stenosis (P ＜0.05).Conclusion Percutaneous transluminal renal angioplasty is a safe procedure for atherosclerotic renal artery stenosis patients,providing a significant improvement in blood pressure control and reduction in the number of oral antihypertensive medications。

Abstract：Background Increasing evidences indicate that an activated renin-angiotensin system (RAS) causes an imbalance between the vasoconstrictive and vasodilator mechanisms involving the pulmonary circulation leading to the development of pulmonary arterial hypertension (PAH).Angiotensin-converting enzyme 2 (ACE2),a primary component of the vasoprotective axis in RAS,is recently identified that it has regulatory actions in lung pathophysiology,but the mechanism in these processes is uncertain yet.Methods Severe PAH was induced by monocrotaline injection one week following pneumonectomy in rats.The activation of ACE2 by continuous injection of resorcinolnaphthalein was studied by real time-polymerase chain reaction (RT-PCR),Western blotting and fluorogenic peptide assay.Endothelial functions were evaluated by the response to acetylcholine and cytokines were measured by RT-PCR seven days after monocrotaline injection.The PAH-related hemodynamics and pathological changes were examined at day 21 when severe PAH was completely established.Results Resorcinolnaphthalein caused significant activation of ACE2 in both normal and diseased rats in 7 days after treatment.The pulmonary arterial pressure (PAP) started to increase at least 7 days after monocrotaline injection,and the rats developed severe PAH in 21 days with high PAP,right ventricular hypertrophy and neointimal formation.Treatment with resorcinolnaphthalein prevented these features.Resorcinolnaphthalein caused an improved endothelia-dependent vasorelaxation and decrease in proinflammatory cytokines (tumor necrosis factor (TNF)-α,monocyte chemoattractant protein-1 (MCP-1),interleukin (IL)-6) and increase in anti-inflammatory cytokine IL-10 in the early stage of the pathogenesis.Conclusions These results demonstrated that activation of ACE2 by continuous injection of resorcinolnaphthalein prevented the development of PAH through improving early endothelial dysfunction and mediating the level of proinflammatory and anti-inflammatory cytokines。

Abstract：Background Cardiac arrest is one of the most serious complications of acute myocardial infarction (AMI),especially in the out-of-hospital patients.There is no general consensus as to whether percutaneous coronary intervention (PCI) is effective in treating ST-segment elevation myocardial infarction (STEMI) patients complicated by out-of-hospital cardiac arrest (OHCA).In our study,we evaluated the efficacy of PCI in treating STEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality,adverse cardiac events,stroke,acute renal failure,and gastrointestinal bleeding events.Methods A total of 1827 STEMI patients were enrolled in this study,where 81 were STEMI with OHCA.Between the patients with and without OHCA,and the OHCA patients with and without PCI,we compared the clinical characteristics during hospitalization,including total mortality and incidences of adverse cardiac events,and stroke.Results Compared to the patients without OHCA,the OHCA patients had significantly lower systolic blood pressure (P ＜0.05) and a faster heart rate (P＜0.05),and a higher percentage of Killip class IV or Glasgow coma scale (GCS) ≤7 onadmission (P ＜0.001).And the in-hospital mortality was higher in the OHCA patients (55.6％ vs.2.4％,P ＜0.001).Comparing the OHCA patients without PCI to the patients with PCI,there was no obvious difference of heart rate,blood pressure or the percentage of Killip class IV and GCS ≤7 on admission,but the incidences of cardiogenic shock,stroke were significantly lower in the with-PCI group during hospitalization (P ＜0.001,P ＜0.05).And the in-hospital mortality of the OHCA patients receiving PCI was significantly lower (36.7％ vs.84.3％,P＜0.001).Conclusions During hospitalization,the incidence of adverse events and mortality are higher in the STEMI with OHCA patients,comparing with the STEMI without OHCA.Emergency PCI reduces the incidence of adverse events and decreases mortality during hospitalization,which is effective for treating STEMI with OHCA patients。

Abstract：Background Patients with esophageal squamous cell carcinoma (ESCC) undergoing definitive chemoradiotherapy (CRT) seem to have a disparity in therapeutic response.The identification of CRT sensitivity-related clinicopathological factors would be helpful for selecting patients most likely to benefit from CRT.Cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) and carcinoembryonic antigen (CEA) have been reported as useful tumor markers for esophageal cancer.The aim of this study was to examine the predictive value of CYFRA21-1 in comparison with CEA and other clinicopathological factors in patients with ESCC treated with definitive CRT.Methods Pretreatment serum CYFRA21-1 and CEA levels were measured by immunoradiometric assays.The relationships between pretreatment clinicopathological factors and the efficacy of CRT were analyzed.Overall survival (OS) was estimated by univariate and multivariate analysis.Results The results from a univariate analysis indicated that the efficacy of CRT was significantly associated with the serum levels of CYFRA21-1 and CEA before treatment (P=0.001 and P=0.023,respectively).It also indicated that the efficacy of CRT was significantly associated with the pretreatment tumor location (P=0.041).By Logistic regression analysis,the independent predictive factor associated with efficacy of CRT was CYFRA21-1 (P=0.002).The OS of the patients with high CYFRA 21-1 levels was worse than that of those with low CYFRA21-1 levels (P=0.001).In multivariate analysis,a low level of CYFRA21-1 was the most significant independent predictor of good OS (P=0.007).Conclusions CEA and tumor location may be useful in predicting the sensitivity of ESCC to CRT.CYFRA21-1 may be an independent predictor for definitive CRT sensitivity in ESCC。

Abstract：Background Patients with pelvic fractures are often treated in hospitals without the capacity to implement an open reduction internal fixation (ORIF).This often leads to pelvic malunion in patients with unstable pelvic fracture,shock or even death due to uncontrollable pelvic hemorrhage and unstable hemodynamics.This study explored the role of early external fixation (within 7 days) for patients with unstable pelvic fractures.Methods A retrospective analysis was conducted on 32 patients with unstable pelvic fractures treated with early external fixation from January 2005 to January 2010 (file type B:18 cases; C:14 cases).The study comprised 28 males and 4 females,with a mean age of (32±8) years (range,21-56 years).Of these patients,22 were treated with emergency pelvic external fixation and 10 were treated with external fixation within 1-7 days.Fifteen cases suffered traumatic hemorrhagic shock.A statistical analysis was conducted to compare fluid infusion and blood transfusion volumes within the first 24 hours of these shock patients with another cohort of patients treated without early external fixation from January 1993 to January 1998.Results The average follow-up was (34.7±14.6) months (range,6-66 months).Six to eight weeks after external fixation,patients could walk with crutches; by 12 weeks,external fixation was removed and all fractures had healed.Seven patients presented with sequelae,including 3 patients with long-term lumbosacral pain,3 patients with erectile dysfunction and 1 patient with Morel-Lavallee lesion and other complications.The 15 shock patients in this study (2005-2010 group) required significantly lower volumes of fluid infusion and blood transfusion (Pfluid=0.000;Ptransfusion=0.000) as compared to the 1993-1998 cohort.Conclusions The early application of external fixation in unstable pelvic fracture patients positively affects hemodynamic stability,with outstanding efficacy as a final fixation option for unstable pelvic fractures。

Abstract：Background Pressure-flow study combined with cystourethroscopy were used as the major method to define female bladder neck obstruction in China.However,the definition of urodynamics for female bladder outlet obstruction (BOO) is not clear so far.Video-urodynamic study (VUDS) would provide more information to define the female BOO,but it is not used commonly due to the limitation of video-urodynamic equipment in China.We attempted to find a better way for diagnosis of female BOO by performing VUDS.Methods VUDS and cystourethroscopy were performed in 38 women with signs and symptoms of difficult voiding from March 2008 to April 2010 in Beijing Chao-Yang Hospital.Bladder neck obstruction was defined by radiological evidence of narrowing bladder neck,voiding pressure greater than 20 cmH2O and maximum flow rate (Qmax) less than 12 ml/s.Transurethral incision of bladder neck was then performed on those patients.Follow-up examination (Qmax and residual urine) was recorded 3 months after operation.Results The mean time from its onset to diagnosis was (18.1±9.1) months in 38 patients.Average patient age was 36.1 years (range from 19 to 79 years).The mean Qmax was (10.6±4.7) ml/s and residual urine was (81.5±42.4) ml.Three out of 38 patients had obvious distal urethral stricture,eight of them suffered from definitely bladder neck contracture and the remaining 27 patients did not show obvious abnormalities measured by cystourethroscopy examination.For the 35 patients without urethral stricture,the most frequent findings of VUDS were high-voiding pressure plus low-flow rate and narrow bladder neck during voiding on simultaneous fluoroscopy examination.With video-urodynamics definition,32 patients were diagnosed as bladder neck obstruction with mean Qmax of (10.8±3.7) ml/s,residual urine of (76.9±32.7) ml and detrusor pressure at maximum flow (PdetQmax) of (50.7±19.1) cmH2O.Other three patients were suffered from detrusor hypocontractility.All 32 patients including eight with definitely bladder neck contracture and 24 with primary bladder neck obstruction received transurethral bladder neck incision.The symptom of difficult voiding was relieved.The postoperative follow-up showed that Qmax was (21.7±7.6) ml/s (P ＜0.01) and the residual urine was (23.2±17.6) ml (P ＜0.01 ).Conclusions The real cause of the obstruction for female patient with difficult voiding might be various.A full VUDS would give us valuable information for correct diagnosis in female patients with bladder neck obstruction。

Abstract：Background Trabeculectomy has become a mainstream treatment in intraocular pressure (IOP) reduction for primary angle-closure glaucoma (PACG); combined trabeculectomy and cataract surgery was reported to reduce lOP and simultaneously improve vision for patients with PACG and coexisting cataract.This study was specialized to compare the efficacy and safety of combined phacotrabeculectomy with that of trabeculectomy only in the treatment of PACG with coexisting cataract.Methods This is a comparative case series study.Thirty-one patients (31 eyes) with PACG and coexisting cataract were enrolled.Of these,17 underwent phacotrabeculectomy and 14 underwent trabeculectomy alone.lOP,filtering blebs,and complications were compared at the final follow-up.Complete success was defined as a final lOP less than 21 mmHg without lOP-lowering medication.Results After 10 months of postoperative follow-up,the phacotrabeculectomy and trabeculectomy groups showed no significant differences regarding IOP reduction ((20.59±7.94) vs.(24.85±14.39) mmHg,P=0.614),complete success rate (88％ vs.71％,P=0.370),formation rate of functioning blebs (65％ (11/17) vs.93％ (13/14),P=0.094),and complications (41％ (7/17) vs.57％ (8/14),P=0.380).lOP-lowering medication was not required for most of the patients in both groups.Additional surgery interventions,including anterior chamber reformation and phacoemulsification,were needed in the trabeculectomy group,whereas no surgery was needed postoperatively in the phacotrabeculectomy group.Conclusion Phacotrabeculectomy and trabeculectomy treatments exhibit similar IOP reduction,successful rates,and complications when it comes to treating PACG patients with coexisting cataract,although additional surgery intervention may be needed for a few cases with cataract and complications after trabeculectomy。

Abstract：Background Oxymatrine has certain antiviral effects in the treatment of chronic hepatitis B (CHB),but its exact mechanism is unclear.The objective of the present study was to explore oxymatrine's antiviral mechanism by studying its effect on the hepatitis B virus (HBV) specific cytotoxic T lymphocyte (CTL) surface programmed death receptor-1 (PD-1)expression in CHB patients.Methods Sixty-five CHB patients who had HBV DNA≥104 copies/ml,positive HBeAg,positive human leukocyte antigen (HLA)-A2,alanine aminotransferase (ALT) ＞2×upper limit of normal value (ULN) were randomly divided into two groups:treatment group (n=33),treated with an intravenous infusion of 600 mg oxymatrine in glucose solution once a day for a month,then with a 200 mg oxymatrine oral capsule three times a day,and a 200 mg silibin meglumine tablet three times a day; control group (n=32) patients were treated only with silibin meglumine tablet,method and dosage were the same as those of treatment group.Three months later,peripheral blood HBV-specific CTL surface PD-1 expression,HBV-specific CTL level,HBV DNA,HBeAg,and results of liver function tests were analyzed and compared.Results Three months post-treatment,in the treatment group,peripheral blood HBV-specific CTL surface PD-1 expression ((19.42±15.94)％) decreased significantly compared to the pretreatment level ((31.30±24.06)％; P ＜0.05),and decreased significantly compared to that of control group three months after treatment ((29.45±21.62)％; P ＜0.05).HBV-specific CTL level ((0.42±0.07)％) significantly increased compared with the pretreatment ((0.29±0.15)％; P ＜0.01),and the control group posttreatment level was (0.31±0.15)％ (P ＜0.05).HBV DNA level in 11 cases became negative (HBV DNA＜500 copies/ml,33.33％),which was higher than that of the control group after treatment (two cases,6.25％;x2=7.45,P ＜0.01),HBeAg of nine cases turned negative (27.27％),which was higher than that of the control group after treatment (one case,3.13％; x2=7.27,P＜0.01).Conclusion Oxymatrine could downregulate peripheral blood HBV-specific CTL surface PD-1 expression in CHB patients,increase HBV-specific CTL level,which may be one of the possible mechanisms by which oxymatrine clears or inhibits HBV in CHB patients。

Abstract：Background Recent studies have demonstrated that the Lenke system is relatively efficient and consistent in classifying scoliosis curves.Basically,fusion should include the main curve and the structural minor curve.The criteria for defining the structural minor curve were established to help guide these decision-making process.The present study was designed to investigate predictors of the structural curve,and see whether it was possible to prevent the formation of the structural curve by interfering with influencing factors to decrease the fusion level.Methods Age,gender,Cobb angle,Perdriolle rotation,Risser sign and the number of vertebrae included in the curve,brace treatment,and curve location were recorded in 145 idiopathic scoliosis patients from July 2001 to January 2007.The patients were divided into two groups:structural and non-structural groups.Demographics and baseline characteristics were compared between the two groups as an initial screen.Logistic regression was used to analyze factors affecting the minor curve to become the structural curve.Results Compared with the non-structural group,the structural group had a higher Cobb angle ((51.34±13.61)° vs.(34.20±7.21)°,P ＜0.001),bending angle ((33.94±9.92)° vs.(8.46±5.56)°,P ＜0.001) and curve rotation ((23.25±12.86)° vs.(14.21±8.55) °,P ＜0.001),and lower flexibility ((33.48±12.53)％ vs.(75.50±15.52)％,P ＜0.001).There was no significant difference in other parameters between the two groups.The results of the Logistic regression analysis showed that the Cobb angle (OR:9.921,P ＜0.001) and curve location (OR.4.119,P=0.016) were significant predictors of structural curve in adolescent idiopathic scoliosis.Every 10° change of Cobb angle increased the possibility of turning the minor curve into the structural curve by 10-fold.And thoracic curve showed,on the average,the possibility of becoming the structural curve about 4-fold more often than did the thoracolumbar/lumbar curve.Conclusions Curve severity and curve location affect the minor curve's structural features in adolescent idiopathic scoliosis。

Abstract：Background Cervicothoracic junction spinal tuberculosis (CJST) in children is uncommon,especially when accompanied by a huge abscess.However,its consequences can be severe.Because of the special anatomic location of the cervicothoracic junction,surgical treatment is difficult and rarely reported.The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement,decompression,allografting and anterior instrumentation in the treatment of CJST in children.Methods Ten pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches.Then an appropriate allograft and titanium plate were applied to reconstruct the spine.The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months.Results The patients were followed-up for an average of 26 months (range,15-32 months).There was no recurrent tuberculous infection.The bone grafts incorporated well and the instrumentation was stable.Cervical and thoracic kyphosis was successfully corrected from 40° (range,30-52°) before the operation to 18° (range,12-26°)post-operation.Neurological function was improved in all patients.Conclusions Combined anterior and posterior approaches for focal debridement,decompression,bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body。

Abstract：Background Angiogenesis occurs commonly in various physiological and pathological processes.Improving blood supply through promoting angiogenesis is a novel approach for treating ischemic diseases.Angiotensin Ⅱ type 1 receptor blockers (ARBs) dominate the management of hypertension,but evidence of their role in angiogenesis is contradictory.Here we explored the angiogenic effects of ARBs through characterizing gene expression of the human umbilical vein endothelial cell line EA.hy926 exposed to irbesartan.Methods The human umbilical vein endothelial cell line EA.hy926 was grown for 72 hours after treatment with different concentrations of irbesartan.The cell proliferative capacity was assessed by CCK8 assay at 24,48 and 72 hours.Gene expression levels in EA.hy926 cells responding to irbesartan were measured under optimal proliferation conditions by microarray analysis using Affymetrix U133 plus 2.0.The differential expression of genes involved in angiogenesis was identified through cluster analysis of the resulting microarray data.Quantitative RT-PCR and Western blotting analyses were used to validate differential gene expression related to the angiogenesis process.Results In the 10-4,10-5,10-6 mol/L treatment groups,cell proliferation studies revealed significantly increased proliferation in EA.hy926 cells after 24 hours of irbesartan treatment.However,after 48 and 72 hours of treatment with different concentrations of irbesartan,there was no significant difference in cell proliferation observed in any treatment group.We selected the group stimulated with irbersartan at a concentration of 10-6 mol/L for microarray experiments.Statistical analysis of the microarray data resulted in the identification of 56 gene transcripts whose expression patterns were significantly correlated,negatively or positively,with irbesartan treatment.Cluster analysis showed that these genes were involved in angiogenesis,extracellular stimulus,binding reactions and skeletal system morphogenesis.Of these 56 genes we identified seven genes (VEGF,KDR,PTGS2,PLXND1,ROBO4,LMO2,and COL5A1) involved in the angiogenesis process.qRT-PCR analysis of these genes confirmed the microarray results.Protein expression of three VEGF pathway genes (VEGF,KDR,and PTGS2) was further confirmed by Western blotting.Conclusions Our study showed that irbesartan may induce angiogenic effects in vascular endothelial cells.It suggested that the mechanism of angiogenic effects of ARBs might be attributed to the signaling cascade from angiotensin receptors in the VEGF pathway.It also provided evidence indicating that ARBs could be used as a novel therapeutic approach to treat chronic ischemic heart disease as well as anti-hypertensive agents。

Abstract：Background Minimally invasive lvor Lewis esophagectomy was usually performed with either hand-sewn or circular stapler anastomosis through a small thoracotomy or using a side-to-side stapler anastomotic technique.This study aimed to present our initial results of lvor Lewis esophagectomy using a circular-stapled anastomosis with transoral anvil technique.Methods Six patients with esophageal cancer underwent minimally invasive lvor Lewis esophagectomy with an intrathoracic circular-stapled end-to-end anastomosis.The abdominal portion was operated on laparoscopically,and the thoracic portion was done using thoracoscopic techniques.A 25 mm anvil connected to a 90 cm long delivery tube was introduced transorally to the esophageal stump in a tilted position,the anvil head was then connected to circular stapler.The anastomosis was completed under direct thoracoscopic view.Results A total of six patients in this report successfully underwent total laparoscopic and thoracoscopic lvor Lewis esophagectomy with a circular-stapled anastomosis using a transoral anvil.They were five male and one female patients,and had a mean age of 55 years (range,38-69 years).The thoracic and abdominal operations were successfully performed without any intraoperative complications or conversion to laparotomy or thoracotomy.The passage of the anvil head was technically easy and successful in all six cases.The mean overall operative time was (260±42) minutes (range,220-300 minutes),and the mean estimated blood loss was (520±160) ml (range,130-800 ml).Patients resumed a liquid oral diet on postoperative day seven.The median length of hospital stay was 17 days (range,9-25 days).The postoperative pathological diagnosis was esophageal squamous cell carcinoma in five patients and esophageal small cell carcinoma in one patient.Tumors were staged as T2N0M0 in three cases,T2N1M0 in one case,and T3N0M0 in two cases.During the mean follow-up of 2.5 months (range,2-4months),there were no intraoperative technical failure of the anastomosis or major postoperative complications such as leak or stricture.Conclusions The initial results of this small series suggest that minimally invasive lvor Lewis esophagectomy for malignant esophageal tumor is technically feasible.However,further multi-center prospective studies and thorough evaluation are needed to evaluate the long-term results。

Abstract：Background As a new electroencephalogram (EEG) signal processing technique for monitoring the depth of anesthesia,entropy consists of two indices:reaction entropy (RE) and state entropy (SE).Our study compared entropy with classical bispectral index (BIS) in reduction of myoelectrical interference and noxious stimuli with EEG signals.Methods Two hundred and eighty patients (ASA Ⅰ-Ⅱ,18-60 years old) undergoing scheduled surgeries from seven medical centers were enrolled.Anesthesia induction was managed with propofol via the target-controlled infusion (TCI)system.The results of BIS,RE,SE,mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia induction,at the moment of unconsciousness,before and 2 minutes after administration of muscle relaxant,and before and one and three minutes after the tracheal intubation.Results The values of half maximum effective concentrations (EC50),5％ effective concentrations (EC05) and 95％ effective concentrations (EC95) of propofol effect-site concentration at the onset of unconsciousness were 1.2 (1.1-1.3μg/ml),2.5 (2.4-2.5 μg/ml) and 3.7 (3.7-3.8 μg/ml),while those of the predicted plasma propofol concentration were 2.8 (2.7-2.9 μg/ml),3.9 (3.8-3:9 μg/ml) and 4.9 (4.8-5.0 μg/ml),respectively.The values of BIS,SE and RE were 62,59 and 63 when 50％ of patients lost consciousness,and 79,80,85 and 42,37,44,respectively,when 5％ and 95％ of patients were unconscious.The values of BIS,RE and SE dropped two minutes after the injection of muscle relaxant,but there were no significant differences between RE and SE.MAP and HR increased visibly,which indicated a reaction to tracheal intubation; the values of BIS,RE and SE,however,did not display any significant changes.Conclusions This large-sample multicentric study confirmed the values of RE and SE as approximating BIS value,at the onset of unconsciousness during propofol TCI anesthesia.After elimination of myoelectrical activation,all values of RE,SE and BIS decreased significantly and the three indices were less sensitive to noxious stimuli than cardiovascular responses。

Abstract：Background It is important to determine the incidence of acute mountain sickness (AMS) among workers at altitudes between 3500 m and 5000 m on Mt.Tanggula during the construction of the Qinghai-Tibet railroad.This study explored the risk factors predisposing workers to developing AMS and attempted to develop more effective ways of preventing and treating AMS.Methods A total of 11 182 workers were surveyed by completing twice daily a Lake Louise questionnaire,and a score ≥3 indicated AMS.The contributing risk factors were assessed for at least 2 months for the duration of the study in the years from 2001 to 2003.A risk model was developed by multiple Logistic regression.Standard statistical methods were used to analyze data.Results AMS occurred in 56％ of workers working at high altitudes on Mt.Tanggula.The incidence of AMS increased with increasing altitude.Rapid ascent to an altitude above 3500 m,sea-level or lowland newcomers,young people under 25 years of age,heavy physical exertion,obese person,and arterial oxygen saturation (SaO2) below 80％ were independent AMS risk factors.No significant association was found between AMS and sex or taking Rhodiola.Medical education contributed to an early diagnosis of AMS.Conclusions This study used the Lake Louise scoring system suggesting that it is a well-validated standard for field evaluation of AMS and for making an early diagnosis.These studies have described many variables regarding risk factors for the development of AMS.Risk factors which can be modified should be attended to,and the physicians should carry out check-ups and tests to identify subjects who are more at risk.Prevention consists in continuous gradual ascent,medical education,and prompt descent to avoid progression in patients with serious AMS.It is most important to effectively control the risk factors of AMS。

Abstract：Background Liddle's syndrome is a rare autosomal-dominant monogenic form of salt-sensitive hypertension.This study aimed to screen the gene mutation in β and y subunits of the epithelial sodium channel (ENaC) of a Chinese family with Liddle's syndrome,an autosomal dominant form of hypertension.Methods DNA samples from the proband with early-onset,treatment-resistant hypertension and suppressed plasma renin activity were initially screened for mutations in the C-terminal exons of the ENaC β or Y subunit genes,usingamplification by polymerase chain reaction and direct DNA sequencing.We also screened the C-terminus of SCNN1B and SCNN1G in family members,and screened for the mutation in 150 controls.Results Genetic analysis of the β ENaC gene revealed a missense mutation of CCC to TCC at codon 616 in the proband,her mother and her grandmother.One hundred and fifty randomly selected controls had not the mutation,indicating that this is not a common genetic polymorphism.There was no mutation of the Y ENaC gene in any of the individuals examined.Conclusions Through direct DNA sequencing analysis,we established the diagnosis of Liddle's syndrome for the proband and her families,and provided tailored therapies to this abnormality.These results provide further evidence that Pro616Ser is a critical amino acid that has a key role in the inhibition of sodium channel activity。

Abstract：Background The p22phox is a critical component of the superoxide-generating vascular nicotinamide adenine dinucleotide phosphate (NADPH) oxidase.Several polymorphisms in p22phox gene are studied for their association with cardiovascular diseases.However,no publication is available to assess the relation of 549C＞T polymorphism in p22phox gene to coronary artery disease (CAD) risk.This study was to investigate the effect of the p22phox gene 549C＞T polymorphism on CAD risk.Methods Hospital-based case-control study was conducted with 297 CAD patients and 343 healthy persons as the control group.Polymerase chain reaction and pyrosequencing using PSQ 96 MA Pyrosequencer (Biotage AB) were used to detect the polymorphisms.Multiple Logistic regression model was used to adjust the potential confounders and to estimate odds ratio (OR) with 95％ confidence intervals (Cls).Results The observed genotype frequencies of this polymorphism obeyed the Hardy-Weinberg equilibrium in both cases (P=0.439) and controls (P=0.668).The frequency of mutant genotypes (TT+CT) in cases (41.08％) was higher than that in controls (36.73％) with an OR=-1.20 (95％ CI=0.87-1.65).After the adjustment of the potential confounders,there was a significant association of the mutant genotypes with increased risk of CAD (OR=1.57,95％ CI=1.01-2.46,P=0.047).Conclusions The mutant genotypes of the p22phox gene 549C＞T polymorphism had a significant effect on the increased risk of CAD in this studied population。

Abstract：Background Right ventricular (RV) dysfunction ensues due to rheumatic mitral stenosis (RMS).The evaluation of RV function is clinically important for the diagnosis,treatment,and follow-up for patients with different degrees of RMS.Thepurpose of this study was to determine whether the 64-slice multi-detector row computed tomography (64-slice MDCT)can assess the RV function in RMS with high accuracy and reproducibility when compared to MR imaging (MRI).Methods Right ventricular end-diastolic and end-systolic volumes (RV-EDV and RV-ESV),stroke volume (RV-SV),ejection fraction (RV-EF),cardiac output (RV-CO),and wall mass (RV-Mass) were measured with dedicated cardiac analysis software on 64-slice MDCT and compared with values measured with MRI in 43 consecutive patients with RMS.Agreement between MRI and 64-MDCT results were compared with Bland and Altman analysis and linear regression analysis.Repeated measurements were performed to determine intraobserver and interobserver variability.Results No significant differences were revealed in calculated RV function parameters between the two methods.RV-EDV,RV-ESV,RV-SV,RV-EF,RV-CO,and RV-Mass by 64-slice MDCT were similar to those by MRI (P＞0.05).There were good correlations (r=0.98,0.97,0.96,0.96,0.95 and 0.77,respectively) and close agreement (bias=-0.2 ml,-1.0ml,0.8 ml,0.5％,26.1 ml,and 0.5 g,respectively,P＞0.05).The variability in 64-slice MDCT measurements was similar to that in MRI values.Conclusion ECG-gated 64-slice MDCT could assess the RV function in RMS with high accuracy and reproducibility when compared to MRI。

Abstract：Hysteroscopic surgery is a minimally invasive procedure for the treatment of intrauterine pathologies.However,it can result in fatal complications.We herein report a case of symptomatic hyponatremia and hyperglycemia during hysteroscopic resection of severe intrauterine adhesion with 5％ dextrose in water as the distension medium.Because of the difficulty of the incision,the infusion pressure was 100 to 150 mmHg,and surgery was continued for 70 minutes.A total of 19 L of 5％ dextrose in water was used as an irrigating fluid.Large-scale absorption of irrigating fluid (3 L) induced dilutional hyponatremia (120 mmol/L) and hyperglycemia (30 mmol/L).Initial signs were abnormal flatulence and postoperative coma.Hypertonic saline,diuretics,insulin,and liquid restriction were the prevailing treatment strategies for hyponatremia and hyperglycemia.Ionized calcium and potassium levels decreased during treatment.We emphasize the importance of prevention,recognition,and a meticulous perioperative treatment standard.Surgical teams must be vigilant in fluid deficit monitoring and serum electrolyte analysis。