2014年 · 第127卷第01期

Chronic respiratory diseases are chronic diseases of the airways and other structures of the lung.Some of the most common are asthma,chronic obstructive pulmonary disease (COPD),respiratory allergies,occupational lung diseases and pulmonary hypertension.Hundreds of millions of people suffer every day from chronic respiratory diseases.COPD is one of the most representative chronic respiratory diseases.A population-based,cross-sectional survey of COPD conducted between 2003 and 2004 showed that the overall prevalence of the disease in people aged above 40 years was 8.2％,1 which would result in a COPD patient population of over 43 million。

Abstract：Background Mycophenolate mofetil (MMF) and cyclophosphamide (CTX) are widely used in treating various kidney diseases.However,whether they are effective and which one is better for treating IgA nephropathy patients with proliferative pathological phenotype in renal diseases,such as endocapillary proliferation,cellular crescents,and/or capillary loops fibrinoid necrosis is still unknown.We,therefore,initiated a study to compare the effects of MMF and CTX in treating IgA nephropathy with the above pathological lesions.Methods One hundred and nineteen patients with IgA nephropathy who had at least one of the three aforementioned lesions were enrolled.All patients were treated with prednisone; 48 patients received prednisone only (Pred group),40 received MMF and prednisone (MMF + Pred group),and 31 were treated with CTX and prednisone (CTX + Pred group).The median time of follow-up was 30 months (maximum:96 months).The primary endpoint was defined as renal survival.The incidence of remission of proteinuria was the secondary endpoint.Results Serum creatinine in all groups declined significantly at different follow-up times (P=0.002),and the differences among the three groups were significant (P＜0.001).At 24 months of follow-up,the decline rates were 12.35％,32.95％,and 24.14％ in the Pred,MMF + Pred,and CTX + Pred groups respectively.For urine protein excretion,the decline rates were 49.12％ (Pred),73.67％ (MMF + Pred),and 63.53％ (CTX + Pred) respectively at 24 months of follow-up.The differences among the three groups were not significant (P=0.714).Renal survival (the primary endpoint) was significantly different (P=0.027); however,the sencondary endpoint was similar for all the three groups (P=0.100).Conclusions For IgA nephropathy patients with endocapillary proliferation,cellular crescents,and/or fibrinoid necrosis of capillary loops,prednisone combined with MMF was more effective in lowering the serum creatinine than with CTX.Combined MMF and orednisone treatment led to a better renal survival compared to that of prednisone with CTX。

Abstract：Background Numerous studies have demonstrated that the peroxisome proliferator-activated receptor-y (PPARy) plays an important role in regulating endothelial progenitor cells (EPC) function.Telmisartan,as a partial agonist of PPARy,may have an effect on the regulation of EPC functions.The purpose of this study was to investigate the effects of telmisartan on EPC proliferation and differentiation.Methods Peripheral blood derived mononuclear cells containing EPC were isolated from healthy volunteers and then cultured on flbronectin-coated dishes in the presence or absence of telmisartan.The proliferative activity of EPC was determined by colony forming units (CFU) and MTT assay.The migratory activity of EPC was assessed by transwell assay.The expression of endothelial cells (EC) markers,including vascular endothelial cadherin (VE-cadherin),yon Willebrand factor (vWF) and endothelial nitric oxide synthase (eNOS),were measured by Western blotting analysis.Results Morphological analysis revealed that telmisartan significantly increased the proliferation of EPC and the number of endothelial cell colony forming units.Telmisartan could enhance the expression of the makers of mature EC,including VE-cadherin,vWF,and eNOS,which indicated telmisartan could stimulate EPC to differentiate into mature EC.Telmisartan increased the phosphorylation of Akt in EPC.The inhibition of Akt activation significantly attenuated the effect of telmisartan on EPC functions,suggesting that Akt is involved in the stimulatory effect of telmisartan on EPC differentiation.Conclusions The results of this study demonstrate that telmisartan promotes EPC functions via activation of Akt。

Abstract：Background Elderly multiple organ dysfunction syndrome (MODS) patients receiving invasive mechanical ventilation have poor prognosis in intensive care units (ICUs).We studied the usefulness of four commonly used severity scores and extrapulmonary factors that affected weaning to predict outcome of such patients.Methods Clinical data of 197 patients on admission to ICUs (from January 2009 to June 2012) were used retrospectively.The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ,APACHE Ⅲ,Sample Acute Physiological Score (SAPS) Ⅱ and MODS scores were calculated.All the patients were grouped into survivors and nonsurvivors according to the prognosis.Patients,who weaned from ventilator (n=154),were subdivided into a successful weaning group and a failed weaning group.The receiver operating characteristic (ROC) curves and Logistic regression was used for prognostic and weaning assessment.Results Based on the outcomes,the areas under the ROC of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,and MODS were 0.837,0.833,0.824,and 0.837,respectively.The Logistic regression analysis revealed that the odds ratio (OR) of underlying lung diseases,serum albumin and creatinine,and the number of organ failures was 2.374,0.920,1.003,and 1.547.APACHE Ⅱ scores on admission performed excellent (ROC:0.921) on the weaning assessments.Conclusions APACHE Ⅱ and MODS systems were marginally better for evaluating the prognosis of elderly MODS patients who received invasive mechanical ventilation.Underlying lung diseases,serum albumin,serum creatinine and the number of organ failures were independent prognostic factors.Using the APACHE Ⅱ scores on admission before weaning may increase the likelihood of successful weaning.(ClinicalTrial.gov identifier NCT01802983)。

Abstract：Background Benign and malignant primary retroperitoneal tumors (RT) have different pathological manifestations,and overlapping imaging characteristics.This study aimed to evaluate the value of computed tomography (CT) for differentiating benign from malignant RT.Methods One hundred and ninety-four patients with clinical and radiographic data were evaluated retrospectively following surgical resection of primary RT.There were 38.1％ (n=74) benign lesions and 61.9％ (n=120) malignant lesions.Categorical variables were tested with a chi-square test or Fisher's exact test for the diagnostic indexes and sensitivity and specificity of CT characteristics.Results In univariate analysis,the differences in ill-defined margins,irregular surfaces,long diameter ＞6.75 cm,short diameter ＞6.25 cm,and solid or mixed texture had statistical significance; the sensitivity and specificity were 44.2％ and 91.9％,70.0％ and 62.2％,68.8％ and 60.7％,59.7％ and 74.2％,87.5％ and 35.1％,respectively.In multivariate analysis,a combination of all the above indexes was the best model for differentiating malignant tumors,resulting in the most accurate diagnosis of malignancies with a sensitivity of 77.2％ and a specificity of 81.1％ (P＜0.0001) when the score was 4.The differences in other findings including CT attenuation,number,and calcification had no statistical significance.The unique characteristics included the spotted enhancement (mottled high density)in schwannoma (P＜0.0001),adipose tissue in liposarcoma (P＜0.0001)and paravertebral location in neurogenic tumors (P＜0.0001).Conclusions More accurate differential diagnosis of primary RT can be made through comprehensive analysis of the combined diagnostic indexes of CT.Some specific characteristics of CT can assist in preoperative planning。

Abstract：Background Lymphoma of the lacrimal sac is rare,often misdiagnosed clinically.This study aimed to investigate the imaging features of these tumors and provide suggestions to aid the diagnosis.Methods In this retrospective study,five cases were assessed according to magnetic resonance imaging (MRI),computed tomography (CT),and pathological findings.All five patients underwent MRI and contrast-enhanced T1-weighted imaging (CE-T1WI),of which four patients underwent dynamic contrast-enhanced (DCE) MRI and three patients underwent CT.Results Four cases and one case had a lymphoma in left and right medial canthus,respectively.Soft tissue surrounding the eyelids,subcutaneous tissue in the nasal dorsum,and involvement of the entire nasolacrimal canal were demonstrated in all five lesions.In two cases,the mass invaded the extraconal space.In one case,the mass invaded the adjacent medial rectus muscle and nasal area.Well-defined margins were observed in three cases and ill-defined margins in two cases.All cases showed homogeneous isointense lesions on T1Wl.Four cases showed homogeneous isointensity and one case demonstrated heterogeneous isointensity on T2Wl.After contrast injection,the lesion showed slight homogeneous isointensity and moderate enhancement in four cases and heterogeneous isointensity and moderate enhancement in one case.In the four patients who underwent DCE-MRI,a plateau pattern was revealed in three cases and washout pattern in one case.In the three cases who underwent CT,two cases had isointense and one case had hyperintense lesions.The lacrimal duct was remodeled and the surrounding bone compressed.Conclusions Tumors of the lacrimal sac showed homogeneous and isointense patterns on T1WI and T2WI with mildto-moderate enhancement and a plateau pattern on DCE-MRI.CT showed remodeling of the lacrimal duct with bone compression。

Abstract：Background The advent of brain stimulation techniques to treat movement disorders and psychiatric diseases has shown potential to decode the neural mechanism that underlies the cognitive process by modulating the interrupted circuit.Here,the present investigation aimed at evaluating the influence of deep brain stimulation of the anterior nucleus thalamus (ANT-DBS) on memory.Methods Thirty-two rats were randomized into phosphate buffer saline (PBS) group (n=8,rats received PBS injections without implantation of electrodes into the ANT),Alzheimer's dementia (AD) group (n=8,rats received Aβ1-40 injections without implantation of electrodes into the ANT),ANT sham stimulation group (n=8,rats received Aβ1-40 injections with implantation of electrodes into the ANT but without stimulation) and ANT stimulation group (n=8,rats received Aβ1-40 injections with implantation of electrodes into the ANT and stimulation).A Morris maze test was used for determining the effect of electrical stimulation on cognitive function in rats.The data were assessed statistically with one-way analysis of variance (ANOVA) followed by Tukey's tests for multiple post hoc comparisons.Results The data showed that in the training test,PBS group and AD group managed to learn the hidden-platform faster and faster while AD group needed a significantly longer time to reach the platform than PBS group (P ＜0.05).Meanwhile,ANT stimulation group demonstrated a significantly shorter time to reach the platform (P ＜0.05) compared to the AD group,while there was no significant difference between the ANT sham stimulation group and the AD group (P ＞0.05).On the probe test,the AD group spent less time ((10.15±2.34) seconds) in the target quadrant than the PBS group ((28.20±2.75) seconds) (P ＜0.05).And the times of platform-traversing of the AD group (3.35±1.12) significantly decreased compared with the PBS group (8.69±2.87) (P ＜0.05).However,the times of platform-traversing and the time spent in the target quadrant of the ANT stimulation group significantly increased compared to the AD group (P ＜0.05),while times of platformtraversing or the time spent in the target quadrant was not significantly different between the ANT sham stimulation group and the AD group (P ＞0.05).Conclusion Bilateral high-frequency stimulation of the ANT may be useful as a potential therapeutic modality for cognitive dysfunction in AD。

Abstract：Background Steroids inhibit osteogenic differentiation and decrease bone formation while concomitantly inducing adipose deposition in osteocytes.This leads to the fatty degeneration and necrosis of bone cells commonly seen in osteonecrosis of the femoral head.The peroxisome proliferator-activated receptor-γ (PPARγ) is an adipogenic transcription factor linked to the development of this disease and responsible for inducing adipogenesis over osteogenesis in bone marrow mesenchymal stem cells (BMSCs).The aim of this study was to assess whether adipogenic differentiation could be suppressed,and thus osteogenic potential retained,by inhibiting PPARy expression in BMSCs.Methods Cells from the bone marrow of New Zealand rabbits were treated with 10-7 mol/L dexamethasone and infected with one of three small interference RNA (siRNA) adenovirus vectors (S1,S2,and S3) or non-targeting control siRNA (Con) and compared with dexamethasone-treated (model) and untreated (normal) cells.Cells were grown for 21 days and stained with Sudan Ⅲ for adipocyte formation.At various time points,cells were also assessed for changes in PPARγ,osteocalcin (OC),Runx2,alkaline phosphatase (ALP) activity,and triglyceride (TG) content.Results Dexamethasone-treated model and control groups showed a significant increase in fatty acid-positive staining,which was inhibited in cells treated with PPARγ siRNA-treated,similar to normal untreated cells.All three siRNA groups significantly inhibited PPARγ mRNA and protein,adipocyte number,and TG content compared with the dexamethasonetreated model and control groups,matching that seen in normal cells.OC and Runx2 mRNA and protein,as well as ALP activity,were significantly higher in cells treated with siRNA against PPARγ,similar to that seen in the normal cells.These osteogenic markers were significantly lower in the dexamethasone-treated cell cultures.Conclusions The siRNA adenovirus vector targeting PPARγ can efficiently inhibit steroid-induced adipogenic differentiation in rabbit BMSCs and retain their osteogenic differentiation potential。

Abstract：Background Increasing age was shown to decrease the requirements for propfol.However,the mechanisms of ageing-induced potentiation of anesthetic actions have not been clearly explored.The aim of this study is to compare the effects of propofol on the field excitatory postsynaptic potentials (fEPSPs) in hippocampal slices of young and aging mice.Methods Brain slices were prepared from C57BL6 male young (2 months) and aging (＞12 months) mice.The dendritic field excitatory postsynaptic potential was recorded from the CA1 stratum radiatum using patch clamp electrophysiological methods.A bipolar concentric stimulating electrode was placed along the Schaffer collateral for othodromic stimulation.The effects of clinically-relevant concentrations of propofol were studied in the young and ageing mouse tissues.Results Propofol application increased the orthodromically evoked fEPSP produced in slices taken from young and older animals.A striking feature in the I/O relationship was the decreased enhancement of the fEPSPs by propofol in slices from older mice.A clinically relevant concentration of propofol,10 μmol/L,showed more significant enhancement in amplitude and area under the curve (AUC) of fEPSP in young compared to tissues from older mice (amplitude:young (24.9±3.4)％,old (4.6±1.6)％; AUC young (30.6±5.4)％,old (2.1±1.7)％).There was no statistically significant difference between the paired-pulse facilitation (PPF) ratios calculated for the responses obtained in tissues from young mice.In slices from older mice,in the presence of 10 μmol/L propofol,PPF was decreased and returned to baseline after washout (baseline 1.21±0.01,propofol:1.16±0.01).Bicuculline (15 μmol/L) blocked the enhancement of propofol on fEPSP in tissues from young and old mice.Conclusion The fEPSP of slices from aging mice demonstrates diminished sensitivity to the enhancing actions of propofol。

Abstract：Background Although pulmonary embolism (PE) with normal blood D-dimer (DD) concentrations is considered rare,in practice the incidence may be greater than is generally believed.Overlooking PE is potentially dangerous.The aim of this study was to explore the incidence and clinical features of PE with normal DD concentrations.Methods We retrospectively analyzed the records of 29 patients with PE and normal DD concentrations from the past seven years.We here compare relevant clinical characteristics of these patients with those of patients with PE and abnormal DD concentrations.We evaluated the probabilities of differences by computing pretest probability scores (Wells score and revised Geneva score).Results The frequency of normal DD concentrations in patients with PE was 4％.Previous episode(s) of PE were more common in patients with normal DD concentrations than in those with abnormal DD concentrations (P=0.001).Fever,tachycardia,and tachypnea occurred less frequently in the former group (P＜0.05) and time between onset of symptoms and DD testing was longer (P=0.001).The diagnosis of PE was delayed in 22 of the 29 cases.Nineteen and seven cases with normal DD concentrations were classified according to pretest scores as intermediate and low risk,respectively.Conclusions PE with normal DD concentrations is uncommon.Although most diagnoses of PE are ruled out by normal DD values,a small number of cases with PE are missed.A combination of pretest probability score and normal DD concentration increases the probability of making the correct diagnosis,but cannot completely exclude patients with suspected PE.When the clinical manifestations cannot be otherwise explained,clinicians should be alert to the possibility of PE with normal DD concentrations in patients with previous episode(s) of PE or a long interval between onset of symptoms and DD testing。

Abstract：Background Critically ill chronic obstructive pulmonary disease (COPD) patients admitted to an intensive care unit (ICU) due to respiratory failure are at particularly high risk of Aspergillus infection.The serum galactomannan index (GMI) has proven to be one of the prognostic criteria for invasive pulmonary aspergillosis (IPA) in classical immunocompromised patients.However,the prognostic value of serum GMI in critically ill COPD patients needs evaluation.The purpose of this study is to investigate the prognostic value of serum GMI in patients with severe COPD.Methods In this single-center prospective cohort study,serum samples for GMI assay were collected twice a week from the first day of ICU admission to the day of the patients' discharge or death.Patients were divided into two groups according to their clinical outcome on the 28th day of their ICU admission.Univariate analysis and survival analysis were tested in these two groups.Results One hundred and fifty-three critically ill COPD patients were included and were divided into survival group (106 cases) and non-survival group (47 cases) according to their outcome.Univariate analysis showed that the highest GMI level during the first week after admission (GMI-high 1st week) was statistically different between the two groups.Independent prognostic factors for poor outcome in severe COPD patients were:GMI-high 1st week ＞0.5 (RR:4.04,95％ CI:2.17-7.51) combined with accumulative dosage of corticosteroids ＞216 mg before the RICU admission (RR:2.25,95％ CI:1.11-4.56) and clearance of creatinine (Ccr) ＜64.31 ml/min (RR:2.48,95％ CI:1.22-5.07).Conclusions The positive GMI-high 1st week (＞0.5) combined with an accumulative dosage of corticosteroids ＞216 mg before the ICU admission and a low Ccr may predicate a poor outcome of critically ill COPD patients。

To the editor:Pulmonary hamartoma is one of the most common benign tumour-like lesions of the lung with the characteristic radiograph appearance of a well-defined,solitary,smooth or slightly lobulated,peripheral pulmonary nodule with the presence of popcorn-like calcification.We report a case of multiple pulmonary hamartomas in a patient with unusual radiology performance。

To the editor:Eosinophilic enteritis (EE) is a rare disease without any underlying primary etiology,which is characterized by eosinophilic inflammation of the bowel wall and various gastrointestinal manifestations.1 The diagnosis of EE is confirmed by a characteristic biopsy and the absence of other known causes of eosinophilia。

To the editor:Invasive tracheobronchial aspergillosis (ITBA) has been gradually recognized.We retrospectively analyzed three cases of ITBA in histologically proven patients from March 2010 to September 2012 with their clinical manifestations,diagnosis,treatment and outcome。

Abstract：Background Nasopharyngeal carcinoma (NPC) is a squamous-cell carcinoma especially prevailing among the natives of southern China.The regimen of concurrent chemoradiotherapy (CCRT) that include platinum and 5-fluorouracil (5-FU)is considered to be the standard treatment for NPC.However,its clinical use is limited by its toxicity.Our purpose was to evaluate the efficacy and safety of the regimen of CCRT with taxanes and platinum versus the regimen of CCRT with 5-FU and platinum in NPC treatment.Methods Medline,the Cochrane library,and the Chinese medical literature database were searched for eligible studies.Meta-analysis was performed using Review Manager (Version 5.2).Results Six random controlled trials (RCTs) including 514 patients met our criteria.Meta-analysis showed that the regimen of CCRT with taxanes and platinum had an improved significant difference in complete remission (CR) and less incidence rate in adverse reactions such as gastrointestinal impairment grades Ⅲll-Ⅳ,liver and kidney impairment grades Ⅰ-Ⅱ,and radiodermatitis grades Ⅲ-Ⅳ versus the conventional regimen of CCRT with 5-FU and platinum,while the long-term effectiveness rate of overall survival,Iocoregional failure-free survival,or distant metastasis failure-free survival between the two groups was therapeutic equivalence.Conclusions The regimen of CCRT with taxanes and platinum in NPC therapy may be more efficient and safe compared to the conventional modality of 5-FU and platinum in CCRT.However,we need more high-quality studies of multi-center and randomized double-blind clinical trials to further compare,analyze,and confirm the findings。

Abstract：Background Several studies investigating the prognostic utility of interleukin-10 (IL-10) in patients with acute coronary syndrome (ACS) have provided conflicting findings.The aim of the study was to assess the existing evidence regarding association between serum IL-10 levels and adverse events.Methods Literature search was performed in PubMed,EMBASE,and Cochrane Trials Register databases from their inception to September 30,2012.In addition,reference lists of the included articles and their related citations in PubMed were also reviewed for additional pertinent studies.Results A total of 12 eligible studies comprising a total of 5882 patients were identified.The pooled relative risks for both studies reporting the risk estimates by IL-10 categories and studies reporting the risk estimates by unit IL-10 indicated an association between high IL-10 levels and adverse events.Sensitivity and subgroup analysis indicated that the results obtained in IL-10 categories were not stable.Conclusions Data from our meta-analysis supported the existence of a relationship between high serum IL-10 levels and adverse events in patients with ACS.Large study with longer follow-up is needed to confirm the findings。

Abstract：Objective The purpose of this descriptive review was to delineate the current knowledge of bronchiectasis in terms of prevalence,burden of disease,pathophysiology,and management.Data sources The National Library of Medicines MEDLINE and PubMed database (2005-2013) were used to conduct a search using the keyword term "bronchiectasis".The references for articles being considered for inclusion were searched from additional sources such as conference proceedings.Study selection Criteria for inclusion of articles included data outlining epidemiology,pathogenesis,diagnosis,and evidence-based guidelines for management of bronchiectasis.In assessing the quality of the articles,factors such as size of the population studied,clinical setting of the study,and whether or not the studies were prospective or retrospective were taken into consideration.Review articles were also included in our data collection.Results Despite many advances in modem medicine,bronchiectasis still remains a significant public health problem in developed countries and the developing world.It carries a significant burden worldwide in terms of morbidity and mortality,as well as financially to the affected population.In addition,bronchiectasis may associate with chronic airflow obstruction,regardless of smoking status.Conclusions Bronchiectasis is a debilitating illness responsible for significant morbidity with a poor health-related quality of life.The condition has a substantial socioeconomic cost because both primary and secondary healthcare resources are frequently used and periods of sick leave are common。

Asthma is a heterogeneous disease that involves a complex interplay of genetic and environmental factors,leading to chronic inflammation and airway remodeling.1,2 The major features that lead to clinical symptoms are infiltration of inflammatory cells,epithelial shedding,mucous gland hyperplasia,increased airway smooth muscle mass and contraction,and sub-epithelial fibrosis,which result in narrowing of the airways and obstruction.1-5 Over 100 years ago,studies used autopsy specimens to investigate the macroscopic morphological and histological changes and established the concept that inflammation was a major component of asthmatic pathology within the large airways。

The infant mortality rate in China declined from 50.2‰ to 13.8‰ between 1991 and 2009.1 Although China has made good progress,there were still about 190 thousand infants who died in 2009.Reliable birth and death registration and the causes of death in populations are essential for public health planning.The National Maternal and Child Mortality Surveillance System (MCMS) is the major system to register maternal and infant deaths.It samples 126 districts and 210 counties,totally 336 sites,covering 12％ of counties and 9％ of the population.Causes of deaths are determined by the attending clinician.For those who die out hospital or clinic,a community health provider will be asked to visit that family and make a decision as to the cause of death。

Chronic pain is a major problem for patients suffering from spinal cord injury (SCI).The prevalence of SCI-related pain ranges from 48％ to 94％ depending on the method of data acquisition and type of pain considered.1 SCI-related neuropathic pain is classified into three subtypes:above-,at-,and below-lesion-level pain.After SCI,it is believed that the dorsal horn of the injured spinal cord expressed increased electrical activity.2 Thus,the neurosurgical procedures for coagulation in the dorsal root entry zone (DREZ) have proved to be most effective in chronic neuropathic pain due to SCI.The aim of this study was to describe the effect and safety ofmicrosurgical DREZ coagulation in treating chronic SCI-related neuropathic pain。

During the spring of 2013,a novel avian-origin influenza A (H7N9) virus emerged and spread in Shanghai.On May 9,2013,33 lab-confirmed cases (2 children and 31 adults) have been reported,among whom 13 died.Among the 31 adult cases of H7N9 avian influenza A virus infections in humans,80.6％ (25/31) were older men (average age 65 years).Clear history of poultry exposure was found in eight patients (8/33,24.3％) and the remaining 21 cases had been suspected poultry exposure.Clustered cases were found in two families (two cases from a father and his son,and the other two cases from a wife and her husband).However,no evidence of human-to-human transmission had been identified.Avian influenza is one of the most dangerous contagions in poultry worldwide,and avian influenza A virus is the major pathogen responsible.Transmission from poultry to humans has now been proven.Some gene segments of the strain have mutated,and further mutations might result in human-to-human transmission。

Myxomas are rare benign tumours,with an estimated incidence of 0.5 per million of population per year.1It is most commonly of left atrial origin (75％ to 90％),less commonly right atrial (10％ to 25％),and rarely ventricular (1％ to 4％).2 Right atrial myomata generally presents as right heart failure,with signs of tricuspid valve disease.The association of pulmonary embolism with right atrial myxoma has been recognized at autopsy for many years。

Glomus tumors are neoplasms derived from specialized cells of glomus bodies surrounding arteriovenous anastomoses.Although most of them are benign,aggressive cases have been described.Glomus tumors can be found throughout the body but are most highly concentrated in the digits,palms,and soles of the feet.It is rare in lung and trachea and the optimal therapy has not been thoroughly described。

A61-year-old woman was admitted to the Department of Vasculocardiology,First Affiliated Hospital of Zhengzhou University presented with recurrent respiratory distress for 2 weeks without fever,cough,phlegm,chest pain or hemoptysis.Her symptom had generally worsened at night when she lying supine,and that could be partly alleviated when she had a seat or stand for a few minutes.Two weeks ago,the patient was admitted to the local hospital with diagnosis of "coronary disease;chronic hepatitis B;stage Ⅱ hypertension".After administered with conservative treatment,her symptoms were not significantly alleviated.The patient was then referred to our hospital in September 2012 for further evaluation and treatment.The patient had a past medical history of hypertension with regular medications of compound kendir lenves (one tablet daily) and reserpine (one tablet daily).Her family history was negative。

The first identified case of human infection with a novel influenza A (H7N9) virus occurred in eastern China during February and March,2013.According to the Center for Disease Control and Prevention (CDC),Chinese mainland has recorded a total of 134 laboratory-confirmed cases of H7N9,among whom 45 died by August.It has spread to eight provinces including Beijing and Shanghai in mainland and,on April 29,it was confirmed to have spread to Taiwan,1 and might be slowly gaining pace daily,about 31％ have died,55％ have recovered,and the rest are still sick and the fatality risk on admission to hospital was 36％ (95％ CI26％-45％) for H7N9。