2012年 · 第125卷第18期

Neuromuscular disorders are commonly encountered in neurological practices.They may lead to significant disability or death.The accurate and early diagnosis of a cause is very important for the effective treatment and reduction in the disability and improved quality of life.A comprehensive history and physical examination is essential to aid classification of the neuromuscular disorder. In some instances,the diagnosis of a specific neuromuscular condition can be made entirely on clinical grounds,such as a patient with carpal tunnel syndrome,while in many cases the presenting sytnptoms are nonspecific and could be the result of several possible etiologies,such as a patient with generalized weakness that may be the result of a myopathy,neuromuscular junction disorder,peripheral neuropathy,or motor neuron disease.Therefore,in practice, ancillary examinations iucluding electrodiagnostic testing,biopsy of muscle and nerve,and molecular diagnostic tests are integral and complementary components of the evaluation of patients with suspected neuromuscular conditions。

Abstract：Background Whether antibody to myelin oligodendrocyte glycoprotein (MOG) can be a diagnostic marker for multiple sclerosis (MS) is still controversial.Recent studies suggested that serum specific anti-MOG epitope antibody might be an MS specific marker.However,these studies did not include neuromyelitis optica (NMO) which might be proven to also have anti-MOG antibody.Hence,the present study was undertaken to investigate the clinical value of serum antibodies to 25 MOG epitopes in conventional MS (CMS) and NMO.Methods Serum anti-MOG epitope IgG was detected in 61 CMS patients,54 NMO patients,and 77 healthy controls,using enzyme-linked immunosorbent assay (ELISA).Results Anti-MOG27-38 IgG levels in both CMS and NMO patients were significantly higher than that in healthy controls (optical density (OD):0.64±0.38,0.48±0.23 vs.0.19±0.09; P=0.000).CMS and NMO patients in relapse stage had significantly higher anti-MOG27-38 IgG level than patients in remission stage (OD:0.55±0.14 vs.0.24±0.09,P=0.027).Conclusion Although serum anti-MOG epitope IgG could not differentiate MS from NMO,it may be a useful marker for monitoring disease activity。

Abstract：Background Growing evidence links alternation of the thyroid function to the pathogenesis and progression of Alzheimer disease (AD).However,only a few studies evaluate the association between thyroid hormone levels and neuropsychiatric manifestations in patients with AD.This study aimed to investigate the relationship of thyroid hormone levels and neuropsychiatric symptoms in euthyroid patients with AD.Methods Forty patients with AD (26 women and 14 men),with no prior AD treatment within 4 weeks before study entry,were evaluated on their thyroid status (total triiodothyronine (TT3),total thyroxine (TT4),and thyroid-stimulating hormone (TSH)),cognition (Mini-Mental State Examination (MMSE) and Alzheimer's disease Assessment Scale-Cognitive Subscale (ADAS-cog)),neuropsychiatric symptoms (Neuropsychiatric Inventory (NPI)) and depression (Hamilton Rating Scale for Depression (HAMD17)).The unique relationship between thyroid hormones and cognitive function and mood was examined with multivariate linear regression analyses.The thyroid status between the neuropsychiatric symptoms group and the non-neuropsychiatdc symptoms group was examined with independent-samples t-test.Results In euthyroid AD patients with agitation and irritability has lower TSH serum level than those without these symptoms (t=-2.130,P ＜0.05; t=-2.657,P ＜0.05); and core score of HAMD is significantly associated with the serum level of TSH (β=0.395,P ＜0.01).There is no significant association between thyroid hormone levels and cognition (MMSE,ADAS-cog and its subscale score).Conclusion There might be a relationship between thyroid hormone levels and the neuropsychiatric symptoms in euthyroid patients with AD。

Abstract：Background There is a paucity of studies investigating the clinical and biochemical characteristics of pain in chronic heart failure (CHF) patients.This study aimed to determine the clinical and biochemical characteristics and outcomes in Chinese patients with CHF and symptoms of pain.Methods Sociodemographics,serum levels of creatinine,NT-proBNP,high-sensitivity C-reactive protein (hs-CRP),tumor necrosis factor (TNF)-α,interleukin (IL)-6 and IL-10,and two-dimensional echocardiographic left ventricular ejection fraction (LVEF) were determined in 305 patients with CHF.A questionnaire packet including the Brief Pain Inventory (BPI) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to assess the degree of pain rated on a 0-10 scale and the quality of life (QOL).A six-minute walking test was performed during routine clinic visits.Major adverse cardiac events (MACE) were recorded; including all-cause or cardiac mortality and rehospitalization because of myocardial infarction,worsening heart failure or stroke at follow-up.Results Pain occurred in 25.6％ of CHF patients,and was more common when the New York Heart Association (NYHA) functional class was worse.More patients with pain were female in gender,and had more co-morbidities,lower LVEF,and shorter distance during the 6-minute walking test.Despite similar serum levels of creatinine,N-terminal prohormone of brain natriuretic peptide (NT-proBNP),IL-6 and IL-10,the TNF-α levels were higher and MLHFQ scores were greater in CHF patients with pain.At follow-up,CHF patients with moderate to severe pain (≥4 scale) had higher rates of all-cause and cardiac mortality and rehospitalization because of myocardial infarction,worsening heart failure or stroke.Multivariate regression analysis revealed that the presence of pain was an independent risk factor for MACE and reduced QOL in CHF patients.Conclusions Pain occurs in all stages of the CHF trajectory,and its incidence increases as clinical functional status is worsened.The presence of pain exerts a negative impact on clinical outcome and QOL in patients with CHF。

Abstract：Background The temporal response to off-pump anteroapical aneurysm plication has not been well defined.We have evaluated the long-term clinical and functional results of this technique and compared the efficacy with the patch modeling repair.Methods From March 2005 to May 2010,163 (115 men and 48 women) consecutive patients were operated on for post-infarction left ventricular aneurysm (LVA),54 patients underwent patch remodeling (group A) and 109 patients underwent off-pump anteroapical aneurysm plication repair (group B).All patients had simultaneous coronary revascularization,other operative procedures included septoplasty in eight and ablation of ventricular tachycardia in six.Follow-up ranged from 1 to 5 years,short-term and mid-term outcomes,including complications,cardiac function,and mortality,were assessed.Results Early mortality was 1.8％ for all patients (group A 1 death vs.group B 2 deaths,not significant (NS)).Peri-operative support included intraaortic balloon pumping in 16 (9.8％),(group A 6 patients vs.group B 10 patients,NS)and inotropic drugs in 84 (51.5％),(group A 34 vs.group B 50,NS).During a mean follow-up of (3.7±0.8) years,eight patients died,with four due to cardiac-related causes.No patient required transplantation,and two required use of an implantable cardioverter-defibrillator for ventricular tachycardia.Survival at 1 and 5 years was 95％ and 86％,respectively.It did not differ significantly between group A and group B.Functional class improved from 2.90±0.59 to 1.65±0.54 among the mid-term survivors (P ＜0.001),with no significant difference between the two groups.Pre-operative risk factors for mortality or poor function were ejection fraction (EF) ＜0.35 (OR=7.9,95％ CI 1.6-40.0); congestive heart failure (CHF) (OR=4.4,95％ CI 1.0-19.0); end-systolic volume index (ESVI) ＞80 ml/m2 (OR=3.7,95％ C/ 1.0-14.0); and advanced age ＞70 years (OR=2.4,95％ C/ 1.0-12.0).Conclusions The technique of off-pump anteroapical aneurysm plication associated with coronary grafting can be performed with low operative mortality,providing good symptomatic relief and long-term survival,and similar results can be achieved with patch modeling repair。

Abstract：Background Minimally invasive cardiac surgery and closed chest cardiopulmonary bypass (CPB) techniques continue to evolve.Previous reports have demonstrated the benefits of fluoroscopy guided cannulation for endovascular CPB during port access cardiac surgery.However,few data are available on the role of transesophageal echocardiography (TEE) guided cannulation for peripheral CPB during robotic cardiac surgery.The purpose of this study was to evaluate TEE guided cannulation for peripheral CPB during robotic cardiac surgery.Methods We performed a retrospective analysis of intraoperative data of 129 consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB from September 2007 to August 2011,which was established using femoral arterial inflow and kinetic venous drainage by way of the femoral vein and right internal jugular vein and a transthoracic aortic cross clamp.TEE was used to guide cannulation of the inferior vena cava (IVC),superior vena cava (SVC),and ascending aorta (AAO).The success rate and the complication rate of TEE guided cannulation for peripheral CPB were evaluated and compared with the results of fluoroscopy guided cannulation in a historical control group.Results One hundred and twenty-nine consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB.There were 67 female (51.9％) and 62 male (48.1％) patients,ranging in age from 13 to 70 years (mean (43.94 ± 13.82) years) and body surface area 1.32 to 2.39 m2 (mean (1.71 ± 0.20) m2).Some 61 (47.3％) patients underwent mitral valve repair,27 (20.9％) mitral valve replacement,27 (20.9％) left atrial myxoma removal,and 14(10.9％) ventricular septal defect repair.Of the 129 patients,TEE guided cannulation of the IVC or SVC was successful in all patients (100％),and no puncture related complications occurred in all patients.Of the 129 patients,successful cannulation of the AAO was achieved in all patients (100％),and aortic perforation occurred in 1 patient (0.78％) under TEE guidance.Of the 42 patients in the historical control group,successful cannulation occured in 39 patients (92.86％),and major complications occurred in 3 patients (7.14％) under fluoroscopy guidance.TEE guided cannulation of the AAO significantly improved success rate (100％ vs.92.86％,P=0.014) and decreased complication rate (0.78％ vs.7.14％,P=0.046).Conclusion TEE may be useful in guiding successful placement of the cannulae in the IVC,SVC,and AAO in the establishment of peripheral CPB during robotic cardiac surgery。

Abstract：Background Coronary endothelial shear stress (ESS) triggered the development of atherosclerosis.However,the effect of calcium channel antagonist on the distribution of ESS remained unclear.Methods Twenty consecutive patients with acute coronary syndrome (ACS) 48 hours after maximal medication with single left anterior descending artery stenosis ＜50％ were studied.Nicardipine was intravenously injected at 1 μg/kg after a bolus of 10 mg in order to achieve mean blood pressure (MBP) reduced by 10％ or more,or the heart rate increased by 10- 15 beats/min.Hemodynamic variables and angiogram at baseline and during injection of nicardipine were recorded,respectively.Coronary artery 3-D reconstruction was used for the analysis of ESS.Results Distal reference-vessel-diameter and minimal lumen diameter decreased significantly from (2.42±0.41) mm and (1.47±0.49) mm at baseline to (2.22±0.35) mm and (1.35±0.49) mm at maximal drug-dosage (P=0.018 and 0.020,respectively).Nicardipine did not change blood velocity.Lowest mean shear stress at segments 2-mm distal to plaque increased significantly from (0.034±0.519) Pa at baseline to (0.603±0.728) Pa (P=0.013) at peak effect of drug.Conclusions Nicardipine was associated with the constriction of diseased vessel segment that adapted to the reduction of blood pressure,without dynamic change of blood velocity at each stage of whole cardiac cycle.Increased ESS value at segments distal to plaque reflected the cardioprotection by nicardipine (ChiCTR-TRC-10000964)。

Abstract：Background Myelosuppression is the main dose-related toxicity of many chemotherapeutic drugs.The human multidrug resistance (mdr1) gene is well-known for its ability to confering drug resistance.In this study,we meant to transplant the placenta mesenchymal stem cells (P-MSCs) moderated by mdr1 gene into a nude mice model radiated by γ-Co60 and to explore the chemoprotection for bone marrow (BM) toxicity.Methods Human P-MSCs were isolated from trypsin-digested term placentas and then transduced by with reconstructed retroviral vector containing mdr1 gene and green fluorescent protein (GFP) reporter gene.The integration and expression of mdr1 gene was observed indirectedly by the expression of GFP.A nude mice model was constructed after irradiation with a sublethal dosage of γ-Co60.These irradiated mice were transplanted with mdr1-MSCs through the caudal vein and then received paclitaxel (PAC) intraperitoneal chemotherapy.The Peripheral peripheral blood (PB) of the nude mice was collected,and the PB cells counts and values were determined using an automatic analyzer.Reeults After PAC treatment,mdr1-MSCs transplanted mice showed markedly improved survival upon compared to MSCs transplanted mice (85.7％ vs.57.1％).White blood cell (WBC) and red blood cell (RBC) counts as well as the hemoglobin (Hb) values were significantly increased in PAC treated mdr1-MSCs mice compared to PAC treated control mice when PAC chemotherapy had been finished (all P ＜0.05),but the difference was not found in the plateltes (PLT)count (P ＞0.05).Conclusion Human P-MSCs moderated by mdr1 gene when transplanted into nude mice may provide chemoprotection for hematopoietic toxicity。

Abstract：Background Rh blood group system is the most complex and immunogenetic blood group system.Prevalent RHD alleles varied in different populations.The purpose of this study is to determine the molecular basis of weak D and DEL phenotype in Anhui Chinese Han population.Methods The D antigen was determined with IgM monoclonal anti-D conformed to the guidelines for donor testing in China.Weak D samples were identified by an indirect antiglobulin test.DEL phenotype was determined by adsorption and elution test.All the RHD 10 exons were screened by PCR with sequence-specific priming or sequenced for the first-time donors who typed weak D,DEL or D negative by serologic test.Results Of all the 30 799 blood donors,155 blood samples were found D negative with IgM anti-D; 34 blood samples were found D positive by indirect antiglobulin test or absorption elution test.RHD alleles were identified by nucleotide sequencing.Total 4 RHD alleles were found including two new.One hundred and twenty of 155 (77.4％) of the serologically D negative samples lacked the RHD gene.One D negative was RHD(615de12).Thirty-two of 155 (20.6％)carried RHD(K409K) among them one carrying 1227G＞A and 845G＞A.Two of 155 (1.3％) was weak D type 15.Conclusions In this study at the molecular level,all DEL phenotype is RHD(K40gK); weak D type 15 is the prevalent weak D allele in Anhui Chinese Han population.Additionally,an improved more efficient method was adopted to amplify all the RHD exons in one PCR program.Our study added to the understanding of molecular mechanisms underlying D antigen expression in Anhui Han population and provided useful information for adopting suitable genotyping strategies in routine use。

Abstract：Background Peritoneal tuberculosis and primary peritoneal carcinoma can both present as an abdominal mass and ascites with elevated serum CA125.The purpose of our study was to evaluate the clinical features of peritoneal tuberculosis,compare them with features of primary peritoneal carcinoma,and establish definitive diagnostic procedures.Methods We conducted a retrospective study in patients with peritoneal tuberculosis from January 1995 to October 2010 at Peking Union Medical College Hospital.During this time,the data of 38 patients with primary peritoneal carcinoma were reviewed.Results The median age was 34 years (range,19-80 years).The most common symptoms were abdominal distension (16/30,53.3％) and an abdominal mass (12/30,40.0％).The serum CA125 level was elevated in 25 patients (83.3％).The median level of cancer antigen CA125 was 392.5 U/ml (range,0.64-850.0 U/ml).Abdominal ultrasound revealed a pelvic mass in 25 patients and ascites in 20 patients.Diagnostic laparoscopy was performed in 15 patients (50.0％) and exploratory laparotomy was performed in 12 patients (40.0％),and 3 patients (10.0％) who underwent laparoscopy converted to laparotomy because of severe adhesions.The intraoperative findings were adhesions,multiple white tubercles,and ascites.Frozen tissue sections were obtained in 17 patients,and 14 of whom showed chronic granulomatous reactions.Final pathological examinations confirmed the diagnosis.Conclusions Peritoneal tuberculosis should be considered as a differential diagnosis,especially for young women with an abdominal mass,ascites,and elevated serum CA125 levels.Laparoscopy is a useful diagnostic method for peritoneal tuberculosis,and intraoperative frozen sections are recommended when the diagnosis is in doubt。

Abstract：Background Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity.This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection.Methods Controlled,randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up.Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups:a fast track group (35 cases) and a conventional care group (35 cases).All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia.Clinical parameters (complication rates,return of gastrointestinal function and postoperative length of stay),stress index and insulin sensitivity were evaluated in both groups perioperatively.Reaults Sixty-two patients finally completed the study,32 cases in the fast-track group and 30 cases in the conventional care group.Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group.We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation.Conclusion Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay。

Abstract：Background It was still rare for the quantitative magnetic resonance imaging (MRI) research of regional changes in hippocampus sclerosis (HS) in Chinese patients with epilepsy.This study aimed to study the hippocampal volumes (HVs)with quantitative MRI measurement in Chinese patients with epilepsy.Methods Forty-six Chinese patients with epilepsy (intractable epilepsy (IE),n=21; non-intractable epilepsy (NIE),n=25)and 25 normal controls were collected between July 2007 and March 2008.All of the subjects underwent a 3T high-resolution MRI with oblique coronal thin sections oriented perpendicular to the hippocampal long axis.Hippocampal structures were assessed by visual detection,and HVs were quantitatively studied with a Picture Archiving and Communication System (PACS).Results Our study suggested that there was no significant difference in gender (P ＞0.05) while the right hippocampal head volume (HHV),hippocampal body volume (HBV),and the whole hippocampal volume (HCV) were greater than the left one (P ＜0.05),but no significant difference was found in bilateral hippocampal tail volume (HTV) (P ＞0.05) in normal controls.That unilateral/diffuse (64％/21％) and bilateral/focal (86％/20％) hippocampal atrophy (HA)were significant in IE and NIE patients,respectively.Anterior hippocampus,especially HHV (26％ in IE and 20％ in NIE) and HBV (29％ in IE and 12％ in NIE),had more significant atrophy than the HTV (5％ in IE and 0％ in NIE) in patients with epilepsy.Conclusion By assessing the volumes of the regional hippocampus with 3T MRI,we could better define the range and distribution of HS,since regional or subtle changes in HVs could be detected earlier with 3T MRI。

To the editor:In a recently published issue,we have greatly enjoyed reading a well-designed study entitled “Three hours continuous injection of adenosine improved left ventricular function and infarct size in patients with ST-segment elevation myocardial infarction”.Zhang et al investigated the erect of 3 hours infusion of adenosine started just after passing of a coronary guidewire during primary percutaneous intervention on left ventricular function and infart size in patients with ST-segment elevation myocardial infarction (STEMI).They reported favorable results with adenosine infusion and,discussed some possible mechanisms and large studies in their article.(1) For better understanding of adenosine-mediated cardioprotection, some additional information appears to be needed。

To the editor:The recent article by Feng et al1 provided for highly interesting reading.Interestingly,the past few years has seen the emergence of new data that suggests that dl-3-n-butylphthalide may have a significant role to play in ameliorating the effects of a number of neurological diseases ranging from ischemia to Parkinson's disease。

Abstract：Background The Fc receptor associated pathway might improve the immune responses against hepatitis B virus (HBV) as previously described by us.In addition,the Flt3 ligand (FL) has been reported to potentiate antigen presenting cells in vivo and may act as a potential adjuvant to boost antigen-specific immune responses.In this study,the immune efficacies of a set of fusion proteins of HBsAg and Fc and/or FL were evaluated in HBsAg transgenic mice.Methods The fusion proteins composed of HBsAg and the Fc domain of murine IgG1 (HBsAg-Fc) and/or the Flt3 ligand,and yeast-derived recombinant HBsAg were used as immunogen to immunize HBsAg transgenic mice,respectively.Serum and liver HBsAg levels,serum anti-HBsAg and cytokine profile,and the activities of alanine aminotransferase (ALT)/AST were investigated after immunization.Results After six injections,the most pronounced decrease in serum and liver HBsAg levels was observed in the HBsAg-Fc immunized group.In addition,serum Th1 cytokines and ALT/AST activities were highest in this group,indicating an effective induction of a favorable cellular immune response.Interestingly,the fusion protein containing HBsAg-Fc and the Flt3 ligand stimulated an alternative Th1-type immune response featured with high level productions of tumor necrosis factor α (TNF- α) and monocyte chemoabstractant protein 1 (MCP-1),causing a more severe cytotoxicity in hepatocytes while showed less effective in reducing serum HBsAg level.Conclusion HBsAg-Fc is effective in eliciting both the humoral and cellular immune responses against HBsAg in HBsAg transgenic mice,which makes it a potential immunogen for the immunotherapy of chronic hepatitis B。

Abstract：Special emphasis about cancer metastasis was concentrated on tumor cells themselves,and we usually considered the ability of migration and invasion was the final decider.Recently,bewaring of tumor microenvironment is a fundamental determinant in metastasis has become the most outstanding breakthrough.Considerable “microbes” in the microenvironment are closely linked with tumor metastatic behaviors,and the major proportion of them is tumor-associated macrophages (TAMs).Actually,TAMs conserve immediate “cross-talk” with cancer cells throughout tumor development.It is generally accepted that TAMs have mostly pro-tumoral functions and play an important role in several stages of tumor progression.This progression involves a series of events that leads from the primary site to the metastatic site,including tumor cell growth,angiogenesis,migration,invasion,intravasation and finally extravasation at distant site where the process begins again (metastasis).Thereby,TAMs has attracted substantial attentions in recent years and could become a promising therapeutic strategy.In this review,we focus on the multi-functions of TAMs in cancer and certain drugs targeting TAMs for cancer treatment those are under experimental research procedures or have even been entered human clinical tests。

Abstract：Epithelial-mesenchymal transition (EMT) is a process by which fully differentiated epithelial cells undergo a phenotypic conversion and assume a mesenchymal cell phenotype,including elongated morphology,enhanced migratory and invasiveness capacity,and greatly increased production of extracellular matrix (ECM) components.The EMTs associated with wound healing,tissue regeneration,and organ fibrosis are termed as type 2 EMT.Over the past two decades,emerging evidence suggested that injured epithelial cells,via type 2 EMT,may serve as important sources of fibroblasts and contribute to organ fibrosis,such as kidney,liver,lung and eyes.There is perhaps no doubt that adult epithelial cells can undergo EMT in vitro in response to transforming growth factor (TGF)-β1 and other inflammatory or pro-fibrotic stimuli.However,whether type 2 EMT really occurs in vivo,whethers it is actually a source of functional and activated interstitial fibroblasts and whether it contributes to tissue fibrosis have already been the subjects of heated debate.In this review,we will describe the main features of EMT,the major findings of type 2 EMT in vitro,the evidences for and against type 2 EMT in vivo and discuss the heterogeneity and pitfalls of the techniques used to detect EMT during fibrotic diseases.We suggest that in order to ascertain the existence of type 2 EMT in vivo,different proper phenotype markers of epithelial and mesenchymal cells should be jointly used and cell lineage tracking techniques should be standardized and avoid false positives.Finally,we believe that if EMT really occurs and contributes to tissue fibrosis,efforts should be made to block or reverse EMTto attenuate fibrotic process。

Abstract：Objective To review the progress of cardiac differentiation and electrophysiological characteristics of bone marrow mesenchymal stem cells.Data sources The databases of PubMed,Springer Link,Science Direct and CNKI were retrieved for papers published from January 2000 to January 2012 with the key words of “bone marrow mesenchymal stem cells,cardiac or heart,electrophysiology or electrophysiological characteristics”.Study selection The articles concerned cardiac differentiation and electrophysiological characteristics of bone marrow mesenchymal stem cells were collected.After excluding papers that study purposes are not coincident with this review or contents duplicated,56 papers were internalized at last.Results For the treatment of myocardial infarction and myocardiac disease,the therapeutic effects of transplantation of bone marrow mesenchymal stem cells which have the ability to develop into functional myocardial cells by lots of methods have been proved by many researches.But the arrhythmogenic effect on ventricles affer transplantation of bone marrow mesenchymal stem cells derived myocardial cells is still controversial in animal models.Certainly,the low differentiation efficiency and heterogeneous development of electricial function could be the most important risk for proarrhythmia.Conclusion Many studies of cardiac differentiation of bone marrow mesenchymal stem cells have paid attention to improve the cardiac differentiation rate,and the electrophysiology characteristics of the differentiated cells should be concerned for the risk for proarrhythmia as well。

Abstract：Objective To review the senescent remodeling of the immune system with aging and its relevance to the increased susceptibility of the elderly to infectious diseases,along with an outlook on emerging immunological biomarkers.Data sources The data selected were from PubMed with relevant published articles in English or French from 1995 to the present.Searches were made using the terms “immunosenescence” and “aging” paired with the following:“innate immunity”,“T-cell”,“B-cell”,“adaptive immunity” and “biomarkers“.Articles were reviewed for additional citations and some information was gathered from web searches.Study selection Articles on aging of both the innate and adaptive immunity were reviewed,with special attention to the remodeling effect on the ability of the immune system to fight infectious diseases.Articles related to biomarkers of immunosenescence were selected with the goal of identifying immunological biomarkers predisposing the elderly to infections.Results Innate immunity is generally thought to be relatively well preserved or enhanced during aging compared with adaptive immunity which manifests more profound alterations.However,evidence,particularly in the last decade,reveals that both limbs of the immune system undergo profound remodeling with aging.Reported data on adaptive immunity is consistent and changes are well established but conflicting results about innate immunity were reported between in vivo and in vitro studies,as well as between murine and human studies.Epidemiological data suggests increased predisposition of the elderly to infections,but no compelling scientific evidence has directly linked senescent immune remodeling to this increased susceptibility.Recently,growing interest in identifying immunological biomarkers and defining “immune risk phenotypes/profiles” (IRP) has been expressed.Identification of biomarkers is in its early days and few potential biomarkers have been identified,with the Swedish having defined one IRP based on the adaptive immune response.Conclusions Aging does not necessarily lead to an unavoidable decline in immune functions.Instead,a complex remodeling occurs.Despite the lack of compelling scientific evidence,senescent immune remodeling surely is a significant contributing factor to the increased risk and severity of infections in the elderly.Although,no immunological biomarker has been formally linked to the increased risk of infections in the elderly,biomarkers remain a promising tool to predict the likelihood of healthy aging,the level of immune competence,and mortality risk in the elderly.Hence,more research is required to define healthy aging and identify immunological biomarkers。

Abstract：Background Y-27632 is a specific inhibitor of Rho-associated coiled kinase (ROCK) and has been shown to promote the survival and induce the differentiation of a variety of cells types.However,the effects of Y-27632 on adult human adipose tissue-derived stem cells (ADSCs) are unclear.This study aimed to investigate the effects of Y-27632 on the neuronal-like differentiation of ADSCs.Methods ADSCs were isolated from women undergoing plastic surgery and cultured.ADSCs were treated with different doses of Y-27632 and observed morphological changes under microscope.The expression of nestin,neuron specific enolase (NSE) and microtubule-associated protein-2 (MAP-2) in ADSCs treated with Y-27632 was detected by immunocytochemistry and Western blotting analysis.Results Y-27632 had the potency to induce neuronal-like differentiation in ADSCs in a dose-dependent manner.Moreover,the differentiation induced by Y-27632 was recovered upon drug withdraw.ADSCs treated with Y-27632 expressed neuronal markers such as NSE,MAP-2 and nestin while untreated ADSCs did not express these markers.Conclusion Selective ROCK inhibitor Y-27632 could potentiate the neuronal-like differentiation of ADSCs,suggesting that Y-27632 could be utilized to induce the differentiation of ADSCs to neurons and facilitate the clinical application of ADSCs in tissue engineering。

Abstract：Background The tendency of tumor cells to disperse throughout the liver is a distinct feature of hepatocellular carcinoma (HCC).Nck family adaptor proteins function to regulate actin cytoskeletal reorganization that leads to cell motility.We previously found that Max binding protein (MNT) was differentially expressed in HCC,and interacted with Nck1 by 2-DE.MNT is a protein member of the Myc/Max/Mad network which plays roles in cell proliferation,differentiation,and death.We investigated the effects of MNT on migration of human liver cancer SK-HEP-1 cells to study the migration regulatory role of MNT in HCC cells.Methods Interaction between MNT and Nck1 was further validated in hepatoma cells by GST-pull down assay and immunoprecipitation,siRNAs specific to MNT (MNT siRNA) were used to knockdown MNT expression.Western blotting,transwell assay were used to determine the migration potential of cells.Results Interaction between MNT and Nck1 was validated in hepatoma cells.MNT knockdown promoted the migration of human liver cancer SK-HEP-1 cells (P ＜0.01 ).Conclusion The results suggest that MNT,via interaction with Nck1,inhibits hepatoma cell migration。

Abstract：Background Transfemoral artery access is the main approach for the interventional treatment of renal artery stenosis (RAS).This study aimed to investigate the technical feasibility of a transradial interventional (TRI) treatment of renal artery stenosis.Methods A series of 23 patients who underwent transradial renal artery stenting from October 2010 to October 2011 were studied.Radial sheath system (Terumo,Japan) was used to get access to the radial artery.Radial tourniquet (Terumo) was used to stop bleeding.A 5Fr MPA (COOK,USA) was used to perform selective renal arteriography.Percutaneous renal artery stent systems were used to perform renal artery stenting.Results Renal artery angiography showed that 15 patients had unilateral renal artery stenosis and eight patients had bilateral renal artery stenosis.The descending aorta could not be catheterized in one patient because of the type Ⅲ aortic arch.Twenty-two patients successfully underwent transradial renal artery angiography and the technical success rate was 95.7％.There was no puncture site hematoma or pseudoaneurysm.Mean procedure time was (38.4±7.2) minutes,the mean amount of contrast agent used was (93.2±6.3) ml,and the mean postprocedure bleeding time was (3.2±1.9) minutes.Conclusion Transradial renal artery intervention is technically reliable with less invasion,rapid recovery,fewer complications and may become an alternative intervention approach for the treatment of renal artery stenosis。

Abstract：Background Bleb-associated endophthalmitis (BAE) is a rare but severe complication of trabeculectomy with poor outcome.Various surgical methods were explored to treat such patients.However,there is no defined protocol.The aim of this study was to describe a new combined operation,and to demonstrate the outcome of the treatment.Methode Nine patients with BAE were enrolled in our study.The combined operation including pars plana vitrectomy (PPV),sclera patch graft (SPG) and endoscopic cyclophotocoagulation (ECP) was used to treat these patients.Results In the follow-up of 18-24 months,all patients with the endophthalmitis were cured,the useful visual acuity was preserved in 7 patients,and the intraocular pressure (IOP) of 8 patients was controlled just after first operation,only one needed another trans-scleral cyclophotocoagulation.Conclusion This combined operation is a useful method for treating the patients with BAE,with SPG and vitrectomy to control the endophthalmitis and ECP to balance the postoperative IOP。

Abstract：Lambl's excrescences are filiform structures attached to the edges of cardiac valves and have been associated with stroke.Here we report two patients with Lambr's excrescences who developed migraine-like headaches followed by cerebral infarction.Their Lambr's excrescences were first identified by transesophageal echocardiography.One patient was given aspirin and another had surgery for debridement of excrescences.Their outcomes were good.The migraine-like headache might be the first symptom of cerebral ischemia and might be triggered by micro-emboli originated from Lambl's excrescences.Patients with Lambl's excrescences should be closely monitored and surgery should be considered in recurrent stroke cases。

Abstract：Capecitabine is an orally available chemotherapeutic agent that is converted to 5-fluorouracil (5-FU) after absorbtion.Capecitabine and its active metabolite,5-FU,have cardiotoxic effects with reported instances of acute coronary syndromes caused due to coronary vasospasm.However,these agents exert toxic effects on cardiovascular system and beyond vasospasm provacation.We report a 46-year-old patient diagnosed as acute inferior infarction who is treated with capecitabine for 3 months due to metastatic breast carcinoma,in whom thrombotic coronary occlusion was observed in angiography.This case demonstrates that apart from vasospasm,coronary thrombosis could be observed after capecitabine treatment,with a possible direct effect of this drug。

Abstract：We present a rare case of colonic metastasis of renal cell carcinoma (RCC) and review the literature.A 54-year-old male was referred to our hospital with a history of bloody stools and fever.A dght kidney tumor measuring about 10 cm in diameter was found by abdominal computed tomography.Right radical nephrectomy and a right hemicolectomy with ileotransversostomy were performed.Pathological diagnosis was chromophobe RCC with sarcomotoid change involving the colon.Chromophobe RCC with sarcomotoid change is very rare。

Rupture of the azygos vein caused by blunt trauma is rare.According to the literature there are total of 21 cases of azygos vein injury since 1978 although the actual occurrence number may be much higher.1,2 Mostly,it is the result of traffic accidents.If the diagnosis and treatment is delayed,patients will be dying of bleeding and hemorrhagic shock.So far its mortality rate is about 40％ for patients with ruptured azygos vein even if they underwent operation.3 We present a patient who had blunt trauma on his left chest,which caused right haemothorax due to ruptured azygos vein。

Neuroendocrine carcinoma (NEC) is a malignant tumor characterized by amine precursor uptake and secretion of amine and polypeptide hormones through decarboxylization.1 NEC is a rare disease,2 with NECs in the aural region being particularly uncommon.We report here a case of NEC in the auditory canal and middle ear。

One of premature twins was noticed with thoracoabdominal ectopia cordis and abdominal-wall defect.Furthermore,the infant was presented with symptoms of tachypnea and moderate cyanosis.Physical examination showed the giant and pulsating omphalocele measured 40 mm × 50 mm over the anterior abdominal wall.Room air oxygen saturation was 82％.Chest X-ray showed absence of the normal contour of heart in the chest,descensus of the heart to the epigastrium (Figure 1A).Echocardiography visualized abdominal ectopia cordis and double-outlet fight ventricle with pulmonary stenosis,the ventricular septal defect and atrial septal defect。