2013年 · 第126卷第05期

Abstract：Background Despite the recent advances in medicine,fever of unknown origin (FUO) remains a diagnostic and therapeutic challenge even to expert physicians.To increase the knowledge of FUO,we conducted a retrospective study to investigate the causes of FUO and the change of major causes of FUO during the past 26 years.Methods The clinical data were retrospectively analyzed from 997 patients with FUO hospitalized at the Peking Union Medical College Hospital (PUMCH) between January 2004 and October 2010.Furthermore,the results were compared to that reported in previous studies of FUO in PUMCH since 1985.Results Of the 997 FUO cases,definite diagnosis was eventually achieved in 797 (79.9％) patients.The most common cause of FUO was infectious diseases (479 cases,48.0％),with tuberculosis accounting for 45.3％ (217/479) of the cases of infections.One hundred and sixty-eight (16.9％) patients were diagnosed with connective tissue diseases,with Still's disease and vasculitis accounted for 31.5％ (53/168) and 24.4％ (41/168) of this category,respectively.Neoplasms and miscellaneous causes were found in 7.9％ (79/997) and 7.1％ (71/997),respectively.However,no definite diagnosis had been made in the remaining 200 (20.1％) cases until they were discharged from the hospital.Conclusions During different periods,infectious diseases,especially tuberculosis,were the leading etiology of FUO and the proportion of tuberculosis had no significant difference.While the frequency of neoplasms was descending,the proportion of lymphoma in neoplasm was ascending; the frequency of undiagnosedcases was increasing,but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data。

Abstract：Background Cardiovascular disease (CVD) is the leading cause of death in patients with end-stage renal disease (ESRD).We explored the relationship between CVD,plasma brain natriuretic peptide (BNP) and copeptin in non-dialysis patients with chronic kidney disease (CKD).Methods BNP and copeptin were measured using ELISA in 86 non-dialysis patients with different degrees of CKD and in 20 control patients.The effects of BNP,copeptin levels and other biochemical indices on carotid ultrasound echocardiography and CVD history were determined using correlation analysis.Results BNP and copeptin levels were significantly higher in the CKD group than in the control group.Both indices increased progressively,in parallel with the decline in glomerular filtration rate (GFR).BNP levels were (184.25±65.18)ng/L in early phase CKD,(975.245±354.09) ng/L in middle phase CKD,and (1463.51±614.92) ng/ml in end phase CKD compared with levels of (101.56±42.76) ng/L in the control group (all P ＜0.01).Copeptin levels in the middle phase ((20.36±9.47) pmol/L) and end phase groups ((54.26±18.23) pmol/L were significantly higher than in the control group ((9.21±2.64) pmol/L; both P ＜0.01).There was no difference in copeptin levels between early phase CKD ((10.09±5.23)pmol/L) and control patients.Stepwise multiple regression analysis identified GFR,intima-media thickness (IMT),left ventricular hypertrophy (LVH),and previous history of CVD as independent risk factors for elevated BNP and copeptin levels.Conclusion BNP and copeptin appear to provide sensitive biological markers for the evaluation of atherosclerosis in non-dialysis patients with CKD。

Abstract：Background Pulmonary thromboendarterectomy (PTE) has evolved as a treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH).This study aimed to characterize if pulmonary oligemia maneuver (POM) can alleviate pulmonary artery injury during PTE procedure.Methods A total of 112 cases of CTEPH admitted to Beijing Anzhen Hospital from March 2002 to August 2011 received PTE procedure.They were retrospectively classified as non-POM group (group A,n=55) or POM group (group B,n=57).Members from group B received POM during rewarming period,whereas members from group A did not.Results There were three (5.45％) early deaths in group A,no death in group B (0) (Fisher's exact test,P=-0.118).Six patients in group A needed extracorporeal membrane oxygenation (ECMO) as life support after the PTE procedure,no patients in group B needed ECMO (Fisher's exact test,P=0.013).The patients in group B had a shorter intubation and ICU stay,lower mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR),higher partial pressure of oxygen in artery (PaO2) and arterial oxygen saturation (SaO2) and less medical expenditure than patients in group A.With a mean follow-up time of (58.3 ± 30.6) months,two patients in group A and one patient in group B died.The difference of the actuarial survival after the procedure between the two groups did not reach statistical significance.Three months post the PTE procedure,the difference of residual occluded pulmonary segment between the two groups did not reach statistical significance (P=-0.393).Conclusion POM can alleviate pulmonary artery injury,shorten ICU stay and intubation time,and lower down the rate of ECMO after PTE procedure。

Abstract：Background Elevating the head of bed (HOB) 30°-45° has been widely supported as a means of ventilator associated pneumonia (VAP) prevention.However,it was poorly adhered in clinical practice.This observational study aimed to investigate the factors impeding this simple practice at the bedside.Methods This prospective study was conducted in 33 Chinese academic hospital intensive care units (ICUs).HOB angle was measured four times daily at 5-7 hour intervals.The predefined HOB elevation goal was an angle ＞30°.Results The overall rate of achieving the HOB goal was 27.8％ of the 8647 measurements in 314 patients during 2842 ventilation days.The HOB goal of ＞3 times/d was consistently achieved only in 15.9％ of the cases.Almost 60％ of patients had at least one 24 hours period during which the HOB goal was never documented.This low rate of protocol compliance was not associated with acute physiology and chronic health evaluation (APACHE) Ⅱ score or dependence on vasopressors.In a survey,"nurse workload" was identified as the most important factor for non-compliance with the HOB goal.In addition,the rates of compliance were significantly different (P ＜0.001) between physicians self-reporting that they either did or did not know the Institutes of Healthcare Improvement (IHI) ventilator bundle.Conclusions Low adherence to a HOB angle of ＞30° was found in this nationwide survey.Nursing workload and lack of knowledge on VAP prevention were important barriers to changing this practice。

Abstract：Baciground Impaired coronary flow reserve (CFR) in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction.Antihypertensive treatment has been shown to improve coronary microvascular dysfunction.The aim of this study was to evaluate the impact of uncontrolled blood pressure (BP) on diagnostic accuracy of CFR for detecting significant coronary stenosis.Methods A total of 98 hypertensive patients scheduled for coronary angiography (CAG) due to chest pain were studied.Of them,45 patients had uncontrolled BP (defined as the office BP ＞140/90 mmHg (1 mmHg=0.133 kPa) in general hypertensive patients,or ＞130/80 mmHg in hypertensive individuals with diabetes mellitus),and the remaining 53 patients had well-controlled BP.CFR was measured in the left anterior descending coronary artery (LAD) during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography (TTDE) within 48 hours prior to CAG.Significant LAD stenosis was defined as ＞70％ luminal narrowing.Diagnostic accuracy of CFR for detecting significant coronary stenosis was analyzed with a receiver operating characteristic analysis.Results CFR was significantly lower in patients with uncontrolled BP than in those with well-controlled BP (2.1±0.6 vs.2.6±0.9,P ＜0.01).Multivariate linear regression analysis of the study showed that the value of CFR was independently associated with the angiographically determined degree of LAD stenosis (β=-0.445,P ＜0.0001) and the presence of uncontrolled BP (β=-0.272,P=0.014).With a receiver operating characteristic analysis,CFR ＜2.2 was the optimal cut-off value for detecting LAD stenosis in all hypertensive patients (AUC 0.83,95％C/0.75-0.91) with a sensitivity of 75％,a specificity of 78％,and an accuracy of 77％.A significant reduction of diagnostic specificity was observed in patients with uncontrolled BP compared with those with well-controlled BP (67％ vs.93％,P=0.031).Conclusions CFR measurement by TTDE is valuable in the diagnosis of significant coronary stenosis in hypertensive patients.However,the diagnostic specificity is reduced in patients with uncontrolled BP。

Abstract：Background Many studies have shown a relationship between birth weight discordance and adverse perinatal outcomes.This study aimed to investigate the perinatal risk factors and neonatal complications of discordant twins who are admitted to the neonatal intensive care unit.Methods A total of 87 sets of twins were enrolled in this retrospective study,of which 22 sets were discordant twins and 65 sets were concordant twins.Binary Logistic regression analysis was used to identify the risk factors associated with the occurrence of discordant twins.The common neonatal complications of discordant twins were also investigated.Results Multivariate analysis showed that the use of assisted reproductive techniques,pregnancy-induced hypertension,and unequal placental sharing were risk factors for the occurrence of discordant twins.The incidence of small for gestational age infants and very low birth weight infants of discordant twins was significantly higher,while the birth weight of discordant twins was significantly lower than those of concordant twins.The duration of hospitalization of discordant twins was longer than that of concordant twins.The incidence of several neonatal complications,such as neonatal respiratory distress syndrome and intracranial hemorrhage,was higher in discordant twins than that in concordant twins.The percentage of those requiring pulmonary surfactant and mechanical ventilation was significantly higher in discordant twins than that in concordant twins.Conclusions Use of assisted reproductive techniques,pregnancy-induced hypertension,and unequal placental sharing are perinatal risk factors of discordant twins who are admitted to the neonatal intensive care unit.These infants are also much more likely to suffer from various neonatal complications,especially respiratory and central nervous system diseases.It is important to prevent the occurrence of discordant twins by decreasing these risk factors and timely treatment should be given to discordant twins。

Abstract：Background Interleukin-23 (IL-23) is a pro-inflammatory cytokine that is thought to be central to the development of autoimmune diseases.This study was conducted to determine whether or not the serum concentration of IL-23 is elevated in patients with rheumatoid arthritis (RA),and to determine the relationship between the IL-23 level and disease activity in RA patients.Methods Serum samples were obtained from 59 patients with RA and 30 healthy controls.The clinical parameters of disease activity were determined,including the 28-joint disease activity score (DAS28),C-reactive protein (CRP),rheumatoid factor (RF) levels,and the degree of bony erosions based on X-rays.The levels of IL-23 and IL-17 were determined by enzyme-linked immunosorbent assay (ELISA).The correlations between the serum levels of IL-23 and disease activity parameters of patients with RA were determined.Results The serum IL-23 level was significantly elevated in patients with RA compared to healthy controls.The serum IL-23 levels in the RA patients correlated with IL-17 and CRP levels,and the DAS28.The levels of IL-23 based on X-ray classification phase Ⅰ,Ⅱ,Ⅲ,and Ⅳ were gradually elevated in RA patients.Conclusions The levels of serum IL-23 in RA patients were higher than in healthy controls.Thus,elevated serum IL-23 levels may be useful markers to detect active RA.In addition,IL-23 is involved in disease progression and bony erosions in patients with RA。

Abstract：Background Recurrence of hepatitis B-related hepatocellular carcinoma (HCC) after curative resection is the leading factor influencing the prognosis of the disease.Therefore,further improvement of long-term survival may depend on the prevention and treatment of the recurrent tumor.The aim of this research was to investigate the role of antiviral therapy and postoperative transcatheter arterial chemoembolization (TACE) in the prevention and treatment of hepatitis B-related HCC recurrence.Methods One hundred and twenty patients who underwent curative resection of hepatitis B-related HCC between January 2005 and June 2008 at our hospital were enrolled.Patients were divided into four groups according to the post-operative adjuvant therapy they received,i.e.,control,antiviral therapy group,TACE group,and combined group.The disease-free survival (DFS) and the 12-,24-,36-month cumulative recurrence rates were studied.Results There was no significant difference between isolated postoperative antiviral therapy group and control in terms of disease-free survival (P=0.283),while it was significantly higher in the TACE group compared to control (P=0.019).In all patients,however,viral prophylactic therapy combined with/without TACE brought a favorable result compared to those only with/without TACE (P ＜0.001).Similarly,no matter combined with or without antiviral treatment,postoperative TACE prolonged DFS (P=0.015).Naturally,a combination of viral prophylactic therapy on the baseline TACE significantly benefited patients' postoperative DFS (P=0.047) and vice verse (P=0.002).The 24-month cumulative recurrence rates of combined group were significantly lower than that of isolated control group and antiviral therapy (P ＜0.001 and P=0.011 respectively).However,36-month recurrence rate was significantly different in the control group compared to the TACE group and combined group (P=0.040 and 0.002 respectively); same as the antiviral group compared to the combined group (P=0.034).Conclusions Post-operative TACE prevents early recurrence while antiviral therapy prevents late recurrence of HCC.Combination of antiviral therapy and TACE are suggested for prevention in HCC patients with high risk of recurrence。

Abstract：Background Recently there has been a great deal of interest in the role of serum uric acid (SUA) in atrial fibrillation (AF).The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation.Methods Three hundred and thirty patients diagnosed with paroxysmal AF were analyzed.Patients were categorized into quartiles on the basis of their pre-operative SUA measurement and follow-up,and Kaplan-Meier estimation with a Log-rank test was used for the analysis of the influence of SUA on the recurrence of AF.Pre-procedural clinical variables were correlated with the clinical outcome after ablation using multivariate Logistic analysis.A Cox proportional hazards model was used to estimate the relationship between SUA and the recurrence of AF.Results After a mean follow-up of (9.341±3.667) (range 3.0-16.3) months,recurrence rates from the lowest SUA quartile to the highest SUA quartile were 16.0％,26.4％,28.3％,and 29.3％ respectively (P=0.014).After adjustment for gender,body mass index (BMI),hypertension,serum levels of high sensitivity C-reactive protein (hsCRP),triglyceride (TG),left atrial diameter (LA),estimated glomerular filtration rate (eGFR),and SUA,there was an increased risk of recurrence in subjects in the highest SUA quartile compared with those in the lowest quartile (hazard ratio 2.804,95％ confidence interval 1.466-5.362,P=0.002).Following multivariate Logistical analysis,SUA was found to be an independent predictor of recurrence (hazard ratio 1.613,95％ confidence interval 1.601-1.625,P=0.014).Conclusion In a retrospective study of patients with paroxysmal AF undergoing catheter ablation,elevated preoperative SUA levels were associated with a higher rate of recurrence of AF。

Abstract：Background The 5,10-methylenetetrahydrofolate reductase (MTHFR) and methionine synthase (MS) are attractive candidates for screening for risk of neural tube defects (NTDs).The aim of the current study was to investigate maternal MTHFR and MS polymorphisms and the interaction between them and their influence on children with NTDs in the Shanxi Province of northern China.Methods Fifty-one mothers who previously had children with NTDs constituted the case group and 51 age-matched mothers with children that were unaffected by any birth defects constituted the control group.All subjects were genotyped for MTHFR C677T and MS A2756G polymorphisms.SPSS 11.5 software package was used for all analyses.Results There was a significant difference for MTHFR genotype distribution for one site (C677T) between the case and control groups.The T allele frequencies were significantly higher in the case group than in the control group (55.9％ vs.35.3％,P ＜0.05).A lack of association was observed for the MS A2756G polymorphism.There was an interaction between the maternal MTHFR C677T genotype and MS A2756G genotype.Conclusion Genetic interaction between MTHFR and MS genes raises the probability of neural tube defects。

Abstract：Background Alcohol has been used for treating simple renal cysts since 1981.Since then,various observational studies have examined the technique,but they differ significantly in the details of the procedures and efficacy measures used.This has made it difficult to assess the safety and efficacy of this technique.We carried out a randomized controlled trial to evaluate the efficacy and safety of ultrasound-guided alcohol sclerotherapy involving single-session multiple injections to treat simple renal cysts.Methods A total of 144 patients with simple renal cysts were randomly allocated to either the treatment group (ultrasound-guided percutaneous drainage and alcohol sclerotherapy with single-session multiple injections) or control group (ultrasound-guided simple percutaneous drainage).Follow-up CT scans of ablated cysts were collected 3 and 6 months after the procedure.The outcome was considered successful if cyst volume between baseline and 6 months decreased by at least 87.5％.Results Intention-to-treat analysis revealed an average volume reduction of 94.2％ in the treatment group and 50.8％ in the control group (P ＜0.0001).The percentage of patients achieving successful outcomes was 88.9％ (95％ CI 77.0％-100.0％) in the treatment group and 22.2％ (95％ CI 6.54％-37.9％) in the control group (P ＜0.0001).The corresponding results in the per-protocol analysis were an average volume reduction of 96.4％ in the treatment group and 50.8％ in the control group (P ＜0.0001).The percentage of patients achieving a successful outcome was 94.3％ (95％ CI 85.6％-100.0％) in the treatment group and 22.2％ (95％ CI 6.54％-37.9％) in the control group (P ＜0.0001).Conclusion Alcohol sclerotherapy involving single-session multiple injections is safe and efficacious in the treatment of renal cysts.(ChiCTR-TRC-10001114,http://www.chictr.org)

Abstract：Background Diabetes has been associated with increased risk of fracture and impaired fracture healing.The aim of this study was to examine the influence of diabetes on perioperative complications,length of stay and ambulatory ability recovery in individuals with hip fracture,and to determine whether changes could be made to improve treatment outcome.Methods The study included 707 hip fracture patients treated at Beijing Jishuitan Hospital between July 2009 and December 2010.The medical history and perioperative complications were compared between non-diabetic and diabetic groups.Length of stay,days awaiting surgery,and days of hospitalization after surgery were also analyzed.Ambulatory ability was compared at 1-year follow-up using the Chi-square test and Fisher's exact test.An independent Student's t-test was used to compare normally distributed continuous data.Results Patients with diabetes were more likely than non-diabetic patients to develop cardiac perioperative complications (8.9％ vs.3.0％,P=-0.021),urinary tract infections (12.0％ vs.2.8％,P ＜0.001),and gastrointestinal symptoms (15.0％ vs.6.8％,P=0.003).No difference in perioperative complications was observed between the groups.Days awaiting surgery and length of hospital stay were both longer in the diabetic group ((8.0±5.1) vs.(6.2±3.7) days and (16.5±3.8) vs.(13.3±3.8) days,P ＜0.001,respectively).Before the occurrence of fracture,patients with diabetes were less likely to be ambulatory outdoors (71.9％ vs.85.9％,P ＜0.001) and had more restricted walking ability.After at least 1-year follow-up,similar proportions of patients in the non-diabetic and diabetic groups (16.1％ and 15.9％,respectively),who were able to ambulate outdoors before the fracture,became housebound till the final follow-up.Conclusions Diabetics are at increased risk of specific complications and have a longer time to surgery and longer in-hospital stay,but generally have similar recovery to non-diabetics thereafter。

Abstract：Background Standardized screening tools for Parkinson syndrome have not been developed for non-westem populations.This study aimed to validate the Copiah County questionnaire (CCQ) as a screening instrument in a Chinese rural population.Methods All participants of a previously reported prevalent study were interviewed using CCQ.The participants who answered yes to at least one item on CCQ were defined as positive.The Parkinson's disease (PD) diagnosis was established using United Kingdom Parkinson's disease Brain Bank Clinical diagnosis criteria (UKPDBBC) and served as a gold standard to determine the sensitivity,specificity,and positive and negative predictive values (PPV,NPV) for the questionnaire.Results Among 16 130 participants,2872 (17.8％) were screened positive for CCQ and 13 258 negative (82.2％).Among the 697 participants diagnosed as having Parkinson syndrome,605 were positive for CCQ,and 92 were negative,leading to a sensitivity of 86.8％.Out of the 15 433 non-Parkinson syndrome participants,13 166 were negative to CCQ,giving a specificity of 85.3％ Among the 2872 participants screened positive,605 were diagnosed with Parkinson syndrome,and their PPV was 21.1％.For the 13 258 participants screened negative on CCQ,92 were diagnosed with Parkinson syndrome and 13 166 did not have Parkinson syndrome,leading to a NPV of 99.3％.Conclusions CCQ appeared to have satisfactory statistical parameters to serve as a screening instrument for Parkinson syndrome in this rural Chinese population.Further studies may prove the utility of this short questionnaire in Parkinson syndrome screening among Chinese populations including those residing in rural areas。

Abstract：Background Varieties of restorative materials are widely used in dentistry.The aim of this study is to explore the influence of different dental restorative materials on bond interface reliability.Methods A two-dimensional finite element analysis method was adopted to simulate the shear-bond efficacy test.The influence of elastic modulus and Poisson's ratio were investigated separately.Several dental restorative materials including resins,metals,and ceramics were analyzed in this study.Results The deformation and peak equivalent stress level of the dentin-adhesive interface rose sharply following a decrease in the elasticity of restorative materials,especially those with a low elastic modulus range.The influence of the Poisson's coefficient was not significant.Ceramics and gold alloy were preferred to resin composite in restorations bearing extensive shear load during service.Conclusions Restorative materials with an elastic modulus similar to that of teeth are not always the best clinical choice.This research provides a helpful guide for the application of different restorative materials in clinical practice。

Abstract：Background Hypoxic-ischemic brain injury (HIBI) after cardiopulmonary resuscitation is one of the most devastating neurological conditions that causing the impaired consciousness.However,there were few studies investigated the changes of brain metabolism in patients with vegetative state (VS) after post-resuscitated HIBI.This study aimed to analyze the change of overall brain metabolism and elucidated the brain area correlated with the level of consciousness (LOC) in patients with VS after post-resuscitated HIBI.Methods We consecutively enrolled 17 patients with VS after HIBI,who experienced cardiopulmonary resuscitation.Overall brain metabolism was measured by F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) and we compared regional brain metabolic patterns from t7 patients with those from 15 normal controls using voxel-by-voxel based statistical parametric mapping analysis.Additionally,we correlated the LOC measured by the JFK-coma recovery scale-revised of each patient with brain metabolism by covariance analysis.Results Compared with normal controls,the patients with VS after post-resuscitated HIBI revealed significantly decreased brain metabolism in bilateral precuneus,bilateral posterior cingulate gyrus,bilateral middle frontal gyri,bilateral superior parietal gyri,bilateral middle occipital gyri,bilateral precentral gyri (PFEw correctecd ＜0.0001),and increased brain metabolism in bilateral insula,bilateral cerebella,and the brainstem (PFEw correctecd ＜0.0001).In covariance analysis,the LOC was significantly correlated with brain metabolism in bilateral fusiform and superior temporal gyri (P uncorrected ＜0.005).Conclusions Our study demonstrated that the precuneus,the posterior cingulate area and the frontoparietal cortex,which is a component of neural correlate for consciousness,may be relevant structure for impaired consciousness in patient with VS after post-resuscitated HIBI.In post-resuscitated HIBI,measurement of brain metabolism using PET images may be helpful for investigating the brain function that cannot be obtained by morphological imaging and can be used to assess the brain area responsible for consciousness。

Abstract：Background Various tissue engineering strategies have been developed to facilitate axonal regeneration after spinal cord injury.This study aimed to investigate whether neural stem cells (NSCs) could survive in poly(L-lactic-co-glycolic acid) (PLGA) scaffolds and,when cografted with Schwann cells (SCs),could be induced to differentiate towards neurons which form synaptic connection and eventually facilitate axonal regeneration and myelination and motor function.Methods NSCs and SCs which were seeded within the directional PLGA scaffolds were implanted in hemisected adult rat spinal cord.Control rats were similarly injured and implanted of scaffolds with or without NSCs.Survival,migration,differentiation,synaptic formation of NSCs,axonal regeneration and myelination and motor function were analyzed.Student's t test was used to determine differences in surviving percentage of NSCs.One-way analysis of variance (ANOVA) was used to determine the differences in the number of axons myelinated in the scaffolds,the mean latency and amplitude of cortical motor evoked potentials (CMEPs) and Basso,Beattie & Bresnahan locomotor rating scale (BBB) score.The X2 test was used to determine the differences in recovery percentage of CMEPs.Results NSCs survived,but the majority migrated into adjacent host cord and died mostly.Survival rate of NSCs with SCs was higher than that of NSCs without SCs ((1.7831±0.0402)％ vs.(1.4911±0.0313)％,P ＜0.001).Cografted with SCs,NSCs were induced to differentiate towards neurons and might form synaptic connection.The mean number of myelinated axons in PLGA+NSCs+SCs group was more than that in PLGA+NSCs group and in PLGA group ((110.25±30.46) vs.(18.25±3.30) and (11.25±5.54),P ＜0.01).The percentage of CMEPs recovery in PLGA+NSCs+SCs group was higher than in the other groups (84.8％ vs.50.0％ and 37.5％,P ＜0.05).The amplitude of CMEPs in PLGA+NSCs+SCs group was higher than in the other groups ((1452.63±331.70) μV vs.(428.84±193.01) μV and (117.33±14.40) μV,P ＜0.05).Ipsilateral retransection resulted in disappearance again and functional loss of CMEPs for a few days.But contralateral retransection completely damaged the bilateral motor function.Conclusions NSCs can survive in PLGA scaffolds,and SCs promote NSCs to survive and differentiate towards neurons in vivo which even might form synaptic connection.The scaffolds seeded with cells facilitate axonal regeneration and myelination and motor function recovery.But regenerating axons have limited contribution to motor function recovery。

Abstract：Background Multidrug resistance (MDR) is a main reason for paclitaxel (TAX) treatment failure.Indirubin-3'-monoxime (IRO) and Matrine are traditional Chinese medicines,which may reverse the resistance of tumor cells to some chemotherapy drugs,but the relationship between paclitaxel resistance and Matrine is still unclear.The aim of this study was to explore the potential molecular mechanism of IRO and Matrine in reversal of TAX resistance.Methods In this study,MTT assay was used to measure the non-cytotoxic dosage of IRO and Matrine on NCI-H520/TAX25 cells and determine the reversal extent of TAX resistance under non-toxic doses.In addition,RT-PCR and Western blotting were used to evaluate the mRNA expression and the protein level of survivin,Oct-4,and Sox-2 in NCI-H520/FAX25 cells using semi-quantitative methods.Results There was no obvious inhibition on sensitive cell strains and drug-resistant strains,when the final concentration was at lest 4 μmol/L for IRO and 100 μmol/L for Matrine.So 4 μmol/L of IRO and 100 μmol/L of Matrine were considered as the reversal dosage.When 4 μmol/L of IRO or 100 μmol/L of Matrine were used together with TAX,the sensitivity to TAX increased evidently in NCI-H520/TAX2 cells; the reversal rate of IRO and Matrine was about 1.92 (43.56/22.6 nmol/L) and 1.74 (43.56/25.0 nmol/L),respectively.The mRNA expression and the protein level of survivin,Oct-4,and Sox-2 in NCI-H520/TAX25 decreased significantly (P ＜0.05) after addition of IRO or Matrine in TAX treatment,compared to that of TAX treatment alone.Conclusion The decrease in both mRNA expression and protein level of survivin,Oct-4,and Sox-2 might be the molecular mechanism,by which IRO and Matrine mediate the reversal of TAX resistance。

Abstract：Background The association between fish consumption and heart failure (HF) incidence is inconsistent.Methods We performed a systematic search of Pubmed and Embase (from 1953 to June 2012) using key words related to fish and HF.Studies with at least three categories of fish consumption reporting both relative risk (RR) and corresponding 95％ confidence interval (CI) for HF incidence were included.The pooled RR and 95％C/were calculated using a fixed or random-effects model.The generalized least squares regression model was used to quantify the dose-response relationship between fish consumption and HF incidence.Results Five prospective cohort studies including 4750 HF events of 170 231 participants with an average of 9.7-year follow-up were selected and identified.Compared with those who never ate fish,individuals with higher fish consumption had a lower HF incidence.The pooled RRs for HF incidence was 0.99 (95％CI,0.91 to 1.08) for fish consumption 1 to 3 times per month,0.91 (95％C/,0.84 to 0.99) for once a week,0.87 (95％C/,0.81 to 0.95) for 2 to 4 times per week,and 0.86 (95％C/,0.84 to 0.99) for 5 or more times per week.An increment of 20 g of daily fish intake was related to a 6％ lower risk of HF (RR:0.94,95％ CI,0.90 to 0.97; P for trend =0.001).Conclusions This meta-analysis suggests that there is a dose-dependent inverse relationship between fish consumotion and HF incidence.Fish intake once or more times a week could reduce HF incidence。

Abstract：Objective This review discusses the current status and progress in studies on fulminant Clostridium difficile colitis (FCDC),including the definition,risk factor,diagnostic role of CT,surgical treatment,postoperative mortality,and new therapeutic strategy.Data sources A literature search was conducted mainly in Medline and PubMed published in English between January 2000 and May 2011.The search terms were "fulminant Clostridium difficile colitis","treatment"","surgery" and "mortality".Resulta Recent studies show that the overall mortality rate for FCDC remains high despite early surgical intervention.It has been difficult to identify the real value for surgical intervention in patients with FCDC due to the absence of prospective,randomized studies.Early recognition of patients with FCDC will help a clinician decide the need for treatment in an intensive care setting,multi-disciplinary consultation,and appropriate therapeutic selection.Some studies emphasize the importance of early recognition and emergent surgery at a less severe stage.Monoclonal antibody therapy and intravenous immunoglobulin treatment may be useful for the treatment of FCDC.Conclusions Present studies do not provide strong evidence for guiding the surgical treatment of FCDC; hence,creation of collaborative research networks is crucial in order to undertake large prospective multi-center studies for improvement in overall survival。

Chronic obstructive pulmonary disease (COPD) is a major global health problem with a rising morbidity and mortality,which is expected to account for about 27％ of tobacco related deaths and is anticipated to move from the fifth to the fourth leading cause of death worldwide from 2002 to 2030.1 COPD is characterized by the abnormal and chronic inflammation induced by cigarette smoking and other inflammatory insults in both small airway and lung parenchyma.2,3 Glucocorticosteroids (also called glucocorticoids,corticosteroids or steroids) are the most effective anti-inflammatory drugs available for the treatment of many chronic inflammatory and immune diseases.4 However,corticosteroids have limited benefit in treating stable COPD5 defined as (relative) steroid insensitivity or resistance6 and may be characteristic of all phenotypes of COPD.Although anti-inflammatory treatments are expected to effectively treat inflammation of COPD,almost all anti-inflammatory approaches risk increasing the extent of infection by blunting host defence mechanisms.Their effectiveness in humans has been limited by various side effects.5 Therefore,it is important to develop a treatment to enhance corticosteroid anti-inflammatory action in COPD。

Salivary gland neoplasms account for 3％-6％ of all head and neck neoplasms,and the incidence was estimated to range from 0.4 to 13.5 cases per 100 000 inhabitants annually.Histologically,salivary gland tumors are a diverse group of neoplasms,making it difficult to establish a common standard for diagnosis and treatment.Most of the current studies concerning salivary gland tumors investigated the histological features and clinical manifestations including both major and minor salivary gland tumors,making it difficult to evaluate their real frequency and site distribution.Parotid tumor is the most frequently occurring salivary neoplasms,comprising 60％-80％ of all salivary gland tumors。

Renal cell carcinoma (RCC) accounts for 85％-90％ of all kidney tumors.Although the majority of renal tumors in surgical series are malignant,a number of patients do undergo nephrectomy for benign lesions.1 Such minimal fat angiomyolipomas (AML) are visually indistinguishable from RCC and present particular diagnostic difficulties.2,3 In this study,CT number in region of whole mass (ROW) is advocated。

To the editor:We found very interesting the paper by Demir et al1 about bone marrow biopsy findings in brucellosis patients.Although brucellosis remains the world's most common bacterial zoonosis,with over half a million new cases annually and prevalence rates in some countries exceeding ten cases per 100 000 population and can result in serious clinical complications,scientific and public health interest and funding for these diseases remain relatively minor and inadequate.2 In the paper by Demir et al,1 forty-eight brucellosis cases were prospectively investigated.Anemia,leukopenia,thrombocytopenia and pancytopenia were found in 39 (81％),28 (58％),22 (46％) and 10 patients (21％),respectively.In addition,hemophagocytosis was observed in 15 (31％) patients。

To the editor:Pregnancy complicated by non-Hodgkns lymphoma (NHL) has rarely been reported.It has been estimated that about 0.76％ (0-1.8％) of NHL cases are accompanied by idiopathic thrombocytopenic purpura (ITP).There are few reports in the medical literature of pregnancy complicated by both NHL and ITP.Here we reported a case。