2013年 · 第126卷第07期

Dyslipidemia,including hypercholesterolemia,hypertriglyceridemia,and low high-density lipoprotein (HDL) cholesterinemia,is a key risk factor to atherosclerosis.The detrimental effect of elevated low-density lipoprotein (LDL) cholesterol and/or decreased HDL cholesterol on cardiovascular disease risk had been well established from previous studies.1 Recently,emerging evidences suggest that dyslipidemia may also be an important contributor to morbidity and mortality of chronic kidney disease (CKD),which has received more and more attention as the prevalence of CKD increases. In our study published in this issue,2 data were collected among 4779 middle-aged and elderly Chinese population.We found that participants with hypercholesterolemia had greater prevalence of albuminuria and reduced estimated glomerular filtration rate (eGFR)。

Abstract：Background Dyslipidemia,a well-known risk factor for cardiovascular disease,is common in patients with kidney disease.Recent studies discerned that dyslipidemias play a critical role in renal damage progression in renal diseases,but the association between dyslipidemias and chronic kidney disease (CKD) in the general population remains unknown.Thus,we assessed whether the growing prevalence of dyslipidemia could increase the risk of CKD.Methods A total of 4779 middle-aged and elderly participants participated in this study.Dyslipidemias were defined by the 2007 Guidelines in Chinese Adults.Incident CKD was defined as albuminuria and/or reduced estimated glomerular filtration rate (eGFR,＜60 ml.min-1.1.73 m-2).Regression analysis was used to evaluate the association between dyslipidemia and albuminuria/reduced eGFR.Results Participants with hypercholesterolemia exhibited a greater prevalence of albuminuria and reduced eGFR (10.0％ vs.6.1％,P=-0.001; 4.0％ vs.2.4％,P=-0.028,respectively).Both hypercholesterolemia and low high density lipoprotein cholesterol (HDL-C) were independently associated with albuminuria (odds ratio (OR) 1.49; 95％ confidence interval (CI) 1.08-2.07 and OR 1.53; 95％ CI 1.13-2.09,respectively).The multivariable adjusted OR of reduced eGFR in participants with hypercholesterolemia was 1.65 (95％ CI 1.03-2.65).As the number of dyslipidemia components increased,so did the OR of CKD:0.87 (95％ CI 0.65-1.15),1.29 (95％ CI,0.83-2.01),and 7.87 (95％ CI,3.75-16.50) for albuminuria,and 0.38 (95％ CI 0.21-0.69),1.92 (95％ CI 1.14-3.25),and 5.85 (95％ CI 2.36-14.51)for reduced eGFR,respectively.Conclusions Our findings indicate that dyslipidemias increase the risk of CKD in the middle-aged and elderly Chinese population.Hypercholesterolemia plays an important role in reducing total eGFR.Both low HDL-C and hypercholesterolemia are associated with an increased risk for albuminuria。

Abstract：Background The prevalence of chronic kidney disease (CKD) and prediabetes has increased in China,and at different rates in different locations.Therefore a community-based screening research was conducted in order to determine the prevalence of CKD and prediabetes,and to analyze associated risk factors of CKD and prediabetes in a city of Southern China.Methods A total of 7801 community residents aged 18 year and older from 6 communities were screened by a stratified random cluster sampling method.An estimated glomerular filtration rate (eGFR),albuminuria,fasting plasma glucose (FPG),and homeostatic model assessment of insulin resistance (HOMA-IR) were measured.Age-standardized prevalence was calculated by the direct method with the use of data on the population distribution in China in 2006.Multivariate logistic analysis was used to analyze the risk factors of CKD and prediabetes,and association of insulin resistance (IR) with CKD and prediabetes was analyzed.Results The age-standardized prevalence of CKD was 12.5％,eGFR ＜60 ml.min-1.1.73 m-2 was 2.7％ and ACR (albumin to creatinine ratio) ＞30 mg/g was 10.3％.The age-standardized prevalence of prediabetes was 12.1％.Logistic regression suggests that IR was a common independent risk factor of CKD and prediabetes.Further analysis show that HOMA-IR was increased with the aggravation of kidney injury and FPG.Conclusion CKD and prediabetes have become a major public health problem in Zhuhai,Southern China; insulin resistance may be an important risk factor。

Abstract：Background A virtual reality simulator provides a novel training model for improving surgical skills in a variety of fields.They can simulate a variety of surgical scenarios to improve the overall skills required for endoscopic operations,and also record the operative process of trainees in real-time and allow for objective evaluation.At present,some simulators for transurethral resection of the prostate (TURP) are available.The utility of virtual reality simulators in training of transurethral prostatectomy was investigated.Methods Thirty-eight urologists were randomly selected to take part in a simulation based training of TURP using the TURPSimTM system.Pre and post-training global rate scale (GRS) scores and objective parameters recorded by the simulator were assessed.Then,questionnaires were filled out.Results Compared with baseline levels,the GRS scores of trainees increased (18.0±4.0 vs.12.4±4.2,P＜0.001),while the rate of capsule resection (26.3％±0.6％ vs.21.2％±0.4％,P ＜0.001),amount of blood loss ((125.8±86.3) ml vs.(83.7±41.6) ml,P ＜0.001),external sphincter injury (3.6±2.9 vs.2.0±2.0,P ＜0.001)decreased significantly after training.Most trainees were satisfied with the simulator based training and believed that the simulator accurately mimicked actual surgical procedures and could help improve their surgical skills.Conclusions As a new method of training on transurethral prostatectomy skills,training of TURP using a virtual simulator can help urologists improve their surgical skills and safety.Therefore,the application of the TURPSimTM system in education and training of urologic surgery is warranted。

Abstract：Background Mycophenolate mofetil (MMF) has been used to prevent transplant rejection for many years and has been shown to have protective effects against renal failure.The objective was to investigate the effect of MMF on monocyte Toll-like receptor 4 (TLR4) signaling in the early stages of renal ischemia/reperfusion injury (IRI) of mice.Methods Sixty BALB/C mice were randomly divided into two groups:an IRI group,in which renal IRI was induced by clamping the renal pedicles for 45 minutes,and an MMF group,in which MMF was given (40 mg·kg-1·d-1,intraperitoneally) from 2 days before renal IRI.The plasma creatinine level and renal tissue damage of each group mice were observed 6,12,24,and 48 hours after reperfusion.The concentration of plasma high-mobility group box 1 (HMGB-1) (TLR4 ligand),interleukin 6 (IL-6),monocyte chemoattractant protein-1 (MCP-1),and tumor necrosis factor α (TNF-α) and the expression of TLR-4 on monocytes were determined.Results The plasma creatinine concentration in the MMF group was lower compared to the IRI group (after reperfusion of 6,12,24,or 48 hours,P ＜0.05).Pathological analysis showed that the renal damage was slighter,TLR-4 expression was reduced (after reperfusion of 6,12,24,or 48 hours,P ＜0.05),and the concentration of cytokines in the plasma was lower (P ＜0.05) in the MMF group.No differences in the concentrations of HMGB-1 were observed (P ＞0.05).Conclusion Monocyte TLR4 signaling is important in the early stage of kidney IRI,but MMF can inhibit it and improve renal function。

Abstract：Background Diabetic nephropathy (DN) is the leading cause of end-stage renal disease.Various treatment regimens and combinations of therapies provide only partial renoprotection.Therefore new approaches are needed to retard the progression of DN.The aim of the present study was to evaluate the role of a novel spiroalkaloid from Acorus tatarinowii named acortatarin A (AcorA) in inhibiting high glucose-induced extracellular matrix accumulation in mesangial cells (MCs).Methods The cytotoxity of AcorA on MCs was examined by 3-(4,5-dimethylthiazol-2-yl)-2.5-diphenyltetrazolium bromide (MTT) assay.The expression of fibronectin and collagen Ⅳ was examined by real time PCR and western blotting.The expression of p22phox and p47phox was detected by western blot.The interaction between p22phox and p47phox was examined by co-immunoprecipitation.The phosphorylation of p47phox was examined by immunoprecipitation.The phosphorylation of protein kinase C (PKC) α,PKCβ,phospholiase C gamma (PLCγ1),and the p85 subunit of PI3K was determined by Western blotting.Results AcorA significantly inhibited high glucose-induced activation of NADPH oxidase,a ROS-generating enzyme,by increasing phosphorylation of p47phox and enhancing interaction between p22phox and p47phox.Preincubation of AcorA with MCs inhibited high glucose-induced collagen Ⅳ and fibronectin production in a dose-dependent manner.Moreover,AcorA attenuated high glucose enhanced phosphorylation of PKCα,PKCβ,PLCγ1,and the p85 subunit of PI3K.Conclusion AcorA inhibits high glucose-induced extracellular matrix production via blocking NADPH oxidase activation。

Abstract：Background The mortality of stroke patients is strongly affected by medical complications.However,there are limited data investigating the effect of in-hospital medical complications on the dependency of stroke patients worldwide.We prospectively and systematically investigated the effect of medical complications on dependency of patients at 3,6 and 12 months after stroke using the China National Stroke Registry (CNSR).Methods This prospective cohort study collected data of patients age ＞18 years with acute ischemic stroke in 132 clinical centers distributed across 32 provinces and four municipalities (including Hong Kong region) of China,from September 2007 to August 2008.Data on medical complications,dependency and other information were obtained from paper-based registry forms.Medical complications associated with stroke outcomes were assessed using multivariable Logistic regression.Results Of 11 560 patients with acute ischemic stroke,1826 (15.80％) presented with in-hospital medical complications.In-hospital medical complications were independent risk factors for dependency of patients at 3 months (adjusted odds ratio (OR) 2.367,95％ confidence interval (CI) 2.021-2.771),6 months (adjusted OR 2.257,95％ CI 1.922-2.650),and 12 months (adjusted OR 1.820,95％ CI 1.538-2.154) after acute ischemic stroke.Conclusion The results demonstrated that the short-term and long-term dependency of acute ischemic stroke patients is significantly associated with in-hospital medical complications in China。

Abstract：Background Aliskiren is a novel blood pressure-lowering agent acting as an oral direct renin inhibitor.The aim of this study was to assess the effect of aliskiren on arterial stiffness,compared with that of ramipril in mild to moderate essential hypertensive patients.Methods Following a two week placebo run-in period,patients with a mean sitting diastolic blood pressure (ms-DBP) ＞95 and ＜110 mmHg (1 mmHg=0.133 kPa),and a mean sitting systolic blood pressure (ms-SBP) ＜180 mmHg were randomly allocated to treatment with aliskiren (150 mg/d,n=20) or ramipril (5 mg/d,n=20) for eight weeks.Blood pressure,plasma renin activity,and the brachial-ankle pulse wave velocity (ba-PWV) were measured before and after eight weeks of treatment.Results Eight weeks of treatment significantly decreased systolic blood pressure and diastolic blood pressure in both the aliskiren group and ramipril group.The hypotensive effect did not differ between the two groups.Plasma renin activity decreased after aliskiren treatment and increased after ramipril treatment.There was no significant difference in baseline ba-PWV between the aliskiren and ramipril groups (P=-0.892).The ba-PWV was significantly reduced in both the aliskiren group (1535 (1405-1666) vs.1464 (1360-1506) cm/s) (P ＜0.01) and the ramipril group (1544 (1433-1673) vs.1447 (1327-1549) cm/s) (P ＜0.01).No statistically significant difference was found in the decline of ba-PWV between the two groups (P=0.766).Conclusions The current study revealed that aliskiren (150 mg/d) could ameliorate arterial stiffness and its effect was similar to ramipril (5 mg/d) in mild to moderate hypertensive patients,indicating that in addition to lowering blood pressure,aliskiren had beneficial effect on vascular protection。

To the editor:Bricker ileal conduit is one kind of surgical modality for urinary diversion.Several anastomoses must be accomplished,mainly including ureteroileostomy and the formation of ileal conduit,which increases the possibilities of urinary leakage.Diagnosis and treatment of potential urinary leaks is a real challenge.1 In this article,we report a complex case of persistent uro-cutaneous fistula after Bricker operation. A 71-year-old man underwent radical cystectomy,Bricker operation and Hartmann operation simultaneously.On day 4 after operation,loose stools polluted the puncture region.The draining liquid became muddy and the output began increasing.Biochemical test showed that creatinine was 4601 μmol/L in the draining liquid.The left ureteral Mono-J stent fell off on the day 12.Regular methods failed to find the urinary leak.Specialists of Interventional Technology Department suggested improving the method of fistulography.(1) A guide wire with flexible tip was inserted into drainage tube and preceded gently.It passed through the fistula and further went into the ileal conduit。

Abstract：Background The double kissing (DK) crush technique is a modified version of the crush technique.It is specifically designed to increase the success rate of the final kissing balloon post-dilatation,but its efficacy and safety remain unclear.Methods Data were obtained from the DKCRUSH-I trial,a prospective,randomized,multi-center study to evaluate safety and efficacy.Post-procedural and eight-month follow-up intravascular ultrasound (IVUS) analysis was available in 61 cases.Volumetric analysis using Simpson's method within the Taxus stent,and cross-sectional analysis at the five sites of the main vessel (MV) and three sites of the side branch (SB) were performed.Impact of the bifurcation angle on stent expansion at the carina was also evaluated.Results Stent expansion in the SB ostium was significantly less in the classical crush group ((53.81±13.51)％) than in the DK crush group ((72.27±11.46)％) (P=-0.04).For the MV,the incidence of incomplete crush was 41.9％ in the DK group and 70.0％ in the classical group (P=-0.03).The percentage of neointimal area at the ostium had a tendency to be smaller in the DK group compared with the classical group ((16.4±19.2)％ vs.(22.8±27.1)％,P=-0.06).The optimal threshold of post-procedural minimum stent area (MSA) to predict follow-up minimum lumen area (MLA) ＜4.0 mm2 at the SB ostium was 4.55 mm2,yielding an area under the curve of 0.80 (95％ confidence interval:0.61 to 0.92).Conclusion Our data suggest that the DK crush technique is associated with improved quality of the final kissing balloon inflation (FKBI) and had smaller optimal cutoff value of post-procedural MSA at the SB ostium。

Abstract：Background There has been a long debate among scholars surrounding the relationship between language and cognition.The worldwide study of aphasia is actively exploring the function of language from cognitive point of view.This study aimed to investigate the relationship between linguistic functions and cognitive functions in a clinical study of Chinese patients with post-stroke aphasia.Methods Cognitive functions of 63 Chinese patients with aphasia following a stroke were assessed with the Chinese version of the second edition of Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery and their linguistic functions were tested with the Western Aphasia Battery (WAB) Scale,respectively.The correlation between the results observed on the LOTCA battery and those on the WAB was analyzed.Aphasia quotient,performance quotient,cortical quotient,and linguistic function of the patients were compared.Then,each language function was analyzed by way of dependent adopt multiple regression analysis.Results The total score of 63 patients as shown on the LOTCA battery was significantly correlated with the aphasia quotient,performance quotient,and cortical quotient observed on the WAB Scale (P ＜0.05,P ＜0.01).However,the correlation between visuomotor organization under LOTCA and repeat under WAB was not significant (P ＞0.05).The attention of LOTCA and WAB's spontaneous speech,repeat,naming,and aphasia quotient was not relevant either (P＞0.05).In addition,correlations between the results observed on the LOTCA battery and the WAB were significant (P＜0.05,P ＜0.01).Among the significant variables finally entered into the standardized canonical discriminant functions,main factors affected the aphasia.Multiple regression analysis showed that orientation,spatial perception,and visual perception had a notable influence on aphasia quotient and naming.Orientation and thinking operation was found to have a notable influence on spontaneous speech.Spatial perception and visual perception was found to have a notable influence on auditory comprehension.Thinking operation and orientation was found to have an obvious influence on reading.Thinking operation,spatial perception,and attention was found to have a notable effect on writing (P ＜0.01).Conclusion There exists a close relationship between linguistic functions and cognitive orientation,spatial perception,visual perception,and thinking operation in a clinical study of Chinese patients with post-stroke aphasia。

Abstract：Background Our previous studies have indicated that the beneficial effects of grafting neural stem cells (NSCs) overexpressing glial cell line-derived neurotrophic factor (GDNF) in rats after stroke.However,the underlying mechanisms are highly debatable.In this study,we investigated whether neurogenesis,Akt,and extracellular signalregulated kinase 1/2 (Erk1/2) signaling were involved in this process.Methods Transient ischemic stroke were induced by occluding middle cerebral artery for 2 hours and reperfusion.At 3 days after reperfusion,GDNF/NSCs,NSCs,and vehicle were administered.Immunohistochemical staining was used to evaluate neurogenesis by nestin antibody; phosphorylation of Akt and Erk1/2 was investigated by Western blotting analysis.Results Transplantation of GDNF/NSCs and NSCs significantly increased nestin-positive cells compared to control group (vehicle) from 1 to 7 weeks after reperfusion,and GDNF/NSCs showed stronger effect than NSCs at 2 and 3 weeks after reperfusion.Meanwhile,enhanced phosphorylation level of Erk1/2 was observed in the GDNF/NSCs and NSCs groups compared with control group,and phosphorylation level of Erk1/2 in GDNF/NSCs group was remarkably higher than that of NSCs group at any given time.In contrast,expression of mitogen-activated protein kinase phosphatase-1 (MKP-1),known as inhibitor of Erk1/2 signaling,was significantly decreased in the GDNF/NSCs and NSCs groups compared with the control group.Moreover,much enhanced and prolonged phosphorylation level of Akt of GDNF/NSCs group was detected compared with control and NSCs group.Conclusion Grafting GDNF/NSCs enhances neurogenesis and activates Akt and Erk1/2 signaling,that may provide the potential for GDNF/NSCs in stroke treatment。

Abstract：Background Noninvasive positive pressure ventilation (NIPPV) has been proposed to shorten the duration of mechanical ventilation in intubated patients,especially those who fail initial weaning from invasive mechanical ventilation (IMV).However,there are also some discrepancies in terms of weaning success or failure,incidence of re-intubation,complications observed during study and patient outcomes.The primary objective of this update was to specifically investigate the role of NIPPV on facilitating weaning and avoiding re-intubation in patients intubated for different etiologies of acute respiratory failure,by comparing with conventional invasive weaning approach.Methods We searched randomized controlled trials (RCTs) comparing noninvasive weaning of early extubation and immediate application of NIPPV with invasive weaning in intubated patients from PubMed,Embase,Cochrane Central Register of Controlled Trials,Web of Knowledge and Springerlink databases.Records from conference proceedings and reference lists of relevant studies were also identified.Results A total of 11 RCTs with 623 patients were available for the present analysis.Compared with IMV,NIPPV significantly increased weaning success rates (odds ratio (OR):2.50,95％ confidence interval (C/):1.46-4.30,P=0.0009),decreased mortality (OR:0.39,95％ CI:0.20-0.75,P=0.005),and reduced the incidence of ventilator associated pneumonia (VAP) (OR:0.17,95％ CI:0.08-0.37,P ＜0.00001) and complications (OR:0.22,95％ CI:0.07-0.72,P=0.01).However,effect of NIPPV on re-intubation did not reach statistical difference (OR:0.61,95％ CI:0.33-1.11,P=0.11).Conclusions Early extubation and immediate application of NIPPV is superior to conventional invasive weaning approach in increasing weaning success rates,decreasing the risk of mortality and reducing the incidence of VAP and complications,in patients who need weaning from IMV.However,it should be applied with caution,as there is insufficient beneficial evidence to definitely recommend it in terms of avoiding re-intubation。

Abstract：Background Unfractionated heparin is the most commonly used anticoagulant in continuous renal replacement therapy (CRRT),but it can increase the risk of bleeding.Citrate is a promising substitute.Our study was to assess the efficacy and safety of citrate versus unfractionated heparin in CRRT.Methods We searched the MEDLINE,the EMBASE,the Cochrane Central Register of Controlled Trials,and the China National Knowledge Infrastructure Database until up to November 2011 for randomized controlled trials comparing citrate with unfractionated heparin in adult patients with acute kidney injury prescribed CRRT.The primary outcome was mortality and the secondary outcomes included circuit survival,control of uremia,risk of bleeding,transfusion rates,acid-base statuses,and disturbance of sodium and calcium homeostasis.Results Four trials met the inclusion criteria.Meta-analysis found no significant difference between two anticoagulants on mortality.Less bleeding and more hypocalcemic episodes were with citrate.Citrate was superior or comparable to unfractionated heparin in circuit life.Conclusions Citrate anticoagulation in CRRT seems to be superior in reducing bleeding risk and with a longer or similar circuit life,although there is more metabolic derangement.Mortality superiority has not been approved。

Abstract：Objective To provide an overview of the current knowledge of growth-differentiation factor 15 (GDF-15) in heart disease.Data sources To identify relevant publications,we searched PubMED database combining the textual terms of heart,cardiac,cardiovascular disease with GDF-15.Study selection Well-controlled,relatively large-scale,retrospective studies as well as meaningful individual cases were all selected as materials.Results GDF-15 is a distant member of the transforming growth factor-β cytokine superfamily.In myocardium,GDF-15 is weakly expressed under physiological conditions.However,its expression level is increased in response to pathological stress.Growing evidence indicate that elevated levels of GDF-15 is a promising prognostic biomarker in cardiovascular diseases.Moreover,GDF-15 exhibits the properties of endogenous anti-hypertrophy of cardiomyocytes and protecting the heart suffering from ischemia and reperfusion insult.Conclusion Ve GDF-15 may be a promising biomarker for evaluation and management of patient with cardiovascular diseases,and have potential protective properties on myocardium。

Abstract：Objective To discuss the clinical ultiliazation and significance of microembolus detection by transcranial Doppler (TCD) sonography in intracranial stenosis-occlusive disease.Data sources All related articles in this review were mainly searched from PubMed published in English from 1996 to 2012 using the terms of microembolic signal,transcranial Doppler,intracranial stenosis,stroke.Study selection Original articles and reviews were selected if they were related to the clinical utilization of microembolus detection in intracranial stenosis-occlusive disease.Results Intracranial stenosis is a significant cause of cerebral emboli,and microembolus detection by TCD sonography were widely used in exploring the mechanisms of ischemic stroke with intracranial stenosis (including the middle cerebral artery stenosis and the vertebral-basilar stenosis),evaluating the prognosis of acute stroke,evaluating the therapeutic effects,and predicting the recurrent events of stroke.Conclusion Microembolus detection by TCD sonography plays an important role in the cerebral ischemic stroke patients with intracranial stenosis。

Hydrogen sulfide (H2S),which was formerly recognized as a colorless,toxic gas,was recently reported to be a novel gasotransmitter.Cystathionine β-synthase (CBS) and cystathionine γ-lyase (CSE) are the two main H2S-generating enzymes characterized by tissue-specific expression.CSE is predominantly located in the heart.1 Like its two cousins nitric oxide (NO) and carbon monoxide (CO),H2S is a simple inorganic molecule with similar properties,such as rapid diffusion and a short life span.H2S is involved in the multi functional regulation of vasodilation,inflammation,cellular cycle,ischemia/reperfusion,oxidative stress and neuromodulation.Duet al firstly described H2S as a messenger molecule in cardiovascular system.Meanwhile,the role of H2S in inflammation has attracted growing interest in recent years as a large number of experiments have been performed to identify its effect in different animal models with multi-target approaches.Further studies have explored the molecular mechanism of action for H2S including the reaction with disulfide groups and metal ions in proteins to regulate enzymatic functions3 and the interplay between H2S and NO.4,5 To date,DL-propargylglycine (PAG) and NaHS are the two principal chemical entities used in related investigations.PAG,an irreversible inhibitor of the H2S-synthesizing enzyme CSE,is permeable to biomembrane and inhibits CSE activity by blocking substrate cysteine from binding to the active site.NaHS produces H2S in vivo and serves as exogenous H2S donor。

Rapamycin was first isolated from a strain of Streptomyces hygroscopicus in the early 1970s from a soil sample taken on Easter Island.1 Because the antiproliferative effects of rapamycin on yeast cell,as well as B and T lymphocytes,it was first identified as an antimicrobial agent with potent immunosuppressive activity and has been used in antirejection therapy.2,3The discovery of rapamycin led to the identification and clone of the mammalian target of rapaymycin (mTOR).mTOR is a highly conserved serine-threonine kinase shown to integrate and coordinate diverse signaling pathway mediated by growth factors,nutrient availability and energy status to play a critical role in cell growth,proliferation,division,migration,and survival.4Structurally,mTOR is a part of two signaling complexes,mTOR complex 1 (mTORC1) and mTORC2。

The major adnexal structures of the skin,the sweat glands,regulate the body temperature.There are two types of sweat glands in the human body,the eccrine type,which produces the NaCl-rich solution in response to heat,and the apocrine type,which releases a lipid-rich secretion.1 Human sweat glands have many immunohistochemical markers which have close relationship with sweat-related diseases.2 Recently,although numerous immunohistochemical markers appeared in sweat glands,these biomarkers scattered in the oceans of literature without a systemic review for the relationship between the immunohistochemical marker and their functions in the counterparts of the sweat glands.It is important for identifying sweat gland-derived neoplasms that originate from or differentiate into the ducts or secretory elements of the sweat glands by immunohistochemical markers.Therefore,it is necessary to make a review of the immunohistochemical markers systematically.Actually,we try to classify the immunohistochemical markers of the sweat glands into four groups according to their protein characters and the functions associated with their presumed physiological counterparts of the sweat apparatus。

Along with the development of digital X-ray imaging technology,a new,economical and practical paper-based output system gradually emerged.To reduce cost,more and more radiologic institutions began to change from film copies to lower-priced paper prints for documenting radiologic findings.1 Therefore,laser paper printers are frequently used as an alternative to duplicating film though the use of printed images is not yet widespread.The aim of this study was to compare the practical value of high-resolution paper printer with dry film copies for detecting small solitary pulmonary nodules (SPNs). METHODS Clinical data Sixty cases (28 cases of SPN,others were negative) of patients for thoracic plain CT scans were deliberately selected by 2 senior doctors in consensus via workstation or picture archiving and communication system (PACS) regarded as a gold standard,and all nodules were confirmed by surgery or clinical follow-up.The diameters of nodules were in the range of 3-20 mm。

Acute mesenteric ischemia is a deadly process with overall mortality rate of 40％.1 Acute thrombosis of an atherosclerotic lesion with previous partial occlusion is one of the common causes.Peri-operative mortality of superior mesenteric artery (SMA) thrombosis is higher because of the difficulty in diagnosis,the extensive nature of the bowel ischemia infarction,and the complex surgical revascularization.2 We described a hybrid approach employing fluoroscopically assisted embolectomy and balloon angioplasty,followed by intra-arterial catheter-directed thrombolysis during laparotomy in patients suffering from acute SMA thrombosis. METHODS Patients The hybrid technique was used in a total of four patients with acute mesenteric ischemia in the last 2 years.The clinical records of all patients were retrospectively reviewed.Only patients with acute SMA thrombosis were included.Patients suffering from acute SMA embolism with a history of atrial tachyarrhytmias were excluded.Co-morbid medical conditions,radiologic findings,complete peri-operative data,and follow-up information were obtained for all patients。

Intrabiliary rupture (IBR)is the most common and potentially fatal complication of Hepatic cystic echinococcosis (HCE).1 Early diagnosis and treatment of IBR is very important,since mortality is high when obstruction of the biliary ducts occurs,leading to ascending cholangitis and septicemia. Between 1999 and 2009,1465 HCE cases were treated surgically in the Hepatic Hydatid Department of the First Teaching Hospital of Xinjiang Medical University,China.Of these cases,62 (4.2％) patients who were diagnosed IBR either pre-,intra-or post-operatively.There were 34 (54.8％) males and 28 (45.2％) females (mean age (32±15) years,range 10-73 years).Fifty-one (82.3％)patients underwent computed tomography (CT),32 (51.6％) patients underwent magnetic resonance cholangiography (MRCP),and 8 (12.9％) patients underwent endoscopic retrograde cholangiopancreatography (ERCP).The cysts were localized in the right hepatic lobe in 38 (61.3％)patients,the left lobe in 15 (24.2％) patients,and bilaterally in 9 (14.5％) patients.A total of 81 cysts were treated in 62 patients,and 15 (24.2％) patients had multiple cysts。

Scalp avulsion is a severe injury.It only occasionally occurs in an industrial accident.Often a sudden entanglement and the instinctively instantaneous pull-out of the long hair into a high-speed rotary machine leads to the disaster.If the damage could not be restored through microsurgery,other methods,including simply replacing the avulsed scalp,or free flap graft from other part of the body,could not live up to aesthetic and functional demand,causing long-time psychological distress.1Reviewing the literature,surgical scalp replantation is not rare.2-5 This report demonstrates a successful salvage in scalp avulsion following hair entrapment in a spinning machine.The clinical result,microvascular quality,and pre-operative management,such as avulsion preservation,blood loss evaluation,and wound compression for bleeding cessation,will also be discussed。

Solitary fibrous tumors (SFTs),which are mostly found in the pleura,have been increasingly described in almost every anatomical location of the body.However,reports of these tumors in the pancreas are still rare.We present a case of SFT in the pancreas and review the clinical characteristics of these l0 cases.A 49-year-old woman presented with a 1-month history of mild pain in the upper abdomen,especially after meals.The patient complained of increasingly greater abdominal distension and a loss of appetite.No jaundice or other symptoms of obstruction were found.A soft fixed mass was palpable in the right upper quadrant without pain.The patient had never suffered from hypoglycemia and the fasting blood-glucagon was within normal levels.Serum laboratory results and tumor markers (AFP,CEA,CA19-9 and CA125) were also within normal limits.A contrast-enhanced CT scan revealed a 13 cm× 10 cm× 10 cm different-density soft-tissue mass in the right upper quadrant,in close relation to the head of the pancreas,with a partially hypo-dense region in the cystic area。

Primary intraosseous meningiomas are a subset of primary extradural meningiomas that arise in bones,and represent about two thirds of primary extradural meningiomas.1 Here we present a case of primary intraosseous meningioma with diffuse and symmetrical invasion of skull and scalp,which was preoperatively diagnosed as fibrous dysplasia.We described the clinical and radiological characteristics,discussed the potential pathogenesis of the diffuse lesion,and presented surgical management. A 32-year-old man was referred for neurosurgical consultation due to an 8-year history of painless,slowly growing huge scalp mass.The patient denied any past surgical history and head trauma.The patient did not present any neurological deficts.Computed tomography (CT) scans (Figure 1A and 1B) revealed diffuse thickening of the cranial vault,especially in the bilateral frontal-temporal-parietal bone。

A 39-year-old man with resistant hypertension,presented with headache and dizziness at the emergency department on January 6,2012.The patient had a history of hypertension for 3 years,his highest blood pressure was 250/110 mmHg,and he was taking antihypertensive medication regimens for at least 6 months.A mitral replacement by bioprosthetic valve had been implanted 6 months before.The patient was in chronic renal failure (CRF) uremia,maintenance of which he underwent the standard hemodialysis treatment three times a week for 6 months.Hemodialysis was done using anti-seepage,bicarbonate dialysate,the German Fresenius 4008S dialysis machine,with a blood flow of an average of 240 ml/min,dialysis flow 500 ml/min,4 hours/time.Coronary artery disease,secondary hypertension,and type 2 diabetes mellitus were excluded.After admission,this patient was subjected to ambulatory blood pressure monitoring and adrenal computed tomography.Estimated glomerular filtration rate (eGFR) was calculated by simple modification of diet in renal disease (MDRD) equation for Chinese.1 All blood samples were taken a day before dialysis in order to exclude interference。

Cervical or thoracic trauma,tracheotomy and tracheal intubation for mechanical ventilation therapy are the main reasons of tracheal stenosis.Recently the incidence of tracheal stenosis is gradually increasing.Tracheal stenosis is an irreversible,progressive disease and the only effective treatment is surgical removal of stenosis tissue to restore normal tracheal lumen.From January 2008 to April 2011,6 patients with thoracic tracheal stenosis in our department underwent tracheotomy and T-tube stent implantation by endoscope with good results.There were 5 male and 1 female patients,aging from 23 to 71 years and the median age was 44 years.The onset time was 1-4 months.Five patients who had undergone general anesthesia surgery and tracheal intubation for 2 to 5 days suffered from progressive dyspnea.One of them had received laser therapy and metal alloy stent therapy but still suffered from tracheal stenosis。

Quinolones have been used to treat various infectious diseases.The addition of fluorine atoms has allowed for extensive modifications of structures,which has enhanced the spectrum of activities and oral bioavailability of quinolones and resulted in the creation of fluoroquinolones.1 Although the adverse effects associated with fluoroquinolone antibiotics have decreased considerably and these drugs are generally well tolerated,adverse effects do sometimes occur.Previous studies have shown that the most common side effects are nausea and diarrhea (＞5％),dizziness (2.5％-3.6％),skin lesions (＜2.5％),central nervous system disorders (1％-2％),and liver function test abnormalities (1.1％).2,3We herein report a patient who suffered from multiple organ dysfunction (MOD) after intravenous infusion of moxifloxacin。

To the editor:Noncompaction of the ventricular myocardium (NVM) can be an isolated condition or co-existed with other congenital cardiac malformations.We report a NVM patient presenting with localized right ventricular aneurysm (VA) formation,atrial septal defect (ASD),and bradycardia,and describe a new tactics by which a dual-chamber pacemaker (PM) was implanted successfully. A 37-year-old male with palpitation and lightheadedness was referred to our hospital for further diagnostic procedures.Two years ago,transthoracic echoeardiography showed dilated ventricle and right atrium (RA),globally hypokinetic left ventricle (LV),thinning hypokinetic myocardium in the apex and outflow tract of right ventricle (RV) and formation of local VA,prominent trabecularization in the lateral wall of right ventricle,and ASD with the diameter of about 10 mm.Deep intertrabecular recesses with flow coming out from RV cavity by color Doppler flow imaging。

To the editor:Active aortic endocarditis is a life-threatening disease associated with considerable morbidity and mortality.1 According to the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for management of patients with heart valve disease,surgical treatment of active native valve endocarditis (NVE) should preferably consist of valve repair because of the risk of infection of prosthetic materials.2 Although homografts are considered as a good option,particularly when there is extensive destruction of surrounding tissue,3 homografts are difficult to obtain in China.We report a successful case of triple cusps replacement with bovine pericardium for active aortic endocarditis。