2013年 · 第126卷第04期

Abstract：Background Cerebral amyloid angiopathy (CAA) is one of the main causes of spontaneous intracranial hemorrhage (ICH).No established link is available between pathological scores of CAA and its outcome.This study aimed to identify the correlations between pathological severity and poor postoperative outcome in the Chinese population.Methods Between May 2006 and April 2011,367 consecutive patients who underwent surgery for CAA-related ICH in 71 hospitals throughout the mainland of China were enrolled in this study.Twelve months after surgery,we evaluated these patients' outcomes according to the modified Rankin Scale (mRS) and statistically correlated risk factors (demographics,medical history,pathological results,and surgical details) that are associated with a favorable (mRS ＜3)and poor (mRS ＞3) outcome groups.Results Risk factors for poor postoperative outcome in 367 patients with CAA-related ICH included advanced age (OR 1.034,95％ Cl 1.001-1.067,P=-0.042),CAA pathology severity (OR 2.074,95％ CI 7.140-16.25,P ＜0.001),lobar hematoma (OR 0.225,95％ Cl 0.104-0.486,P ＜0.001),presence of intraventricular hemorrhage (OR 0.478,95％ CI 0.229-1.001,P=-0.050),and/or subarachnoid hemorrhage (OR 2.629,95％ CI,1.051-6.577,P=-0.039).Conclusions Poor postoperative outcome of patients with CAA-related ICH was more related to the severe pathological manifestation instead of other factors.Prior ischemia may present an early stage of CAA。

Abstract：Background Patients with multivessel coronary artery disease and depressed left ventricular ejection fraction (LVEF)represent a high risk group of patients for coronary revascularization.There are limited data on percutaneous coronary intervention treatment in this population.Methods Among a cohort of 4335 patients with three-vessel disease with or without left main disease undergoing percutaneous coronary intervention,191 patients had LVEF ＜40％ (low ejection fraction (EF)) and 4144 patients had LVEF ＞40％.In-hospital and long-term outcomes were examined according to LVEF.Results The estimated two-year rates of major adverse cardiac events,cardiac death,and myocardial infarction were significantly higher in the low EF group (19.64％ vs.8.73％,Log-rank test:P ＜0.01; 10.30％ vs.1.33％,Log-rank test:P ＜0.01,and 10.32％ vs.2.28％,Log-rank test:P ＜0.01 respectively),but there was no difference in the rates of target vessel revascularization (6.18％ vs.6.11％,Log-rank test:P=0.96).Using the Cox proportional hazard models,LVEF ＜40％ was a significant risk factor for cardiac death,myocardial infarction,and major adverse cardiac events (OR (95％CI):4.779 (2.369-9.637),2.673 (1.353-5.282),and 1.827 (1.187-2.813) respectively),but was not a statistically significant risk factor for target vessel revascularization (OR (95％ CI):1.094 (0.558-2.147)).Conclusion Among patients undergoing percutaneous coronary intervention for multivessel coronary artery disease,left ventricular dysfunction remains associated with further risk of cardiac death in-hospital and during long-term follow-up。

Abstract：Background The initial classic classification of duplex kidney into complete (two ureters) and incomplete ("Y" shaped ureter) types are based on the ureter status.At the meantime,the features of the upper and lower moieties of duplex kidney were very crucial for appropriate procedure of hemi-nephrectomy,which was most commonly used for addressing the issues caused by a duplex kidney; and recently more applications of laparoscopy were used.In this study,we aimed prudently to propose a new classification based on the features of the upper and lower moieties of duplex kidney.Methods Sixty-five children with 83 duplex kidneys were reviewed retrospectively.Based on kidney morphology found in CT urography and surgical findings,duplex kidney was classified into five types.Results The first was the appendant type (36/83) and its feature was that the mini upper moiety was located on top of the lower one,with a visualized shallow groove between them.The ureter was dilated with an ectopic orifice or ureterocele.The second was the embedded type (13/83),the feature of which was that mini upper moiety located in the interior top of the lower one within the same capsule.The upper ureter was dilated with an ectopic orifice or ureterocele.The third was the hydronephrosis type (12/83).The severe hydronephrotic upper moiety was almost as big as the lower moiety.The upper ureter was severely dilated and circuitous with an ectopic orifice.The forth was the dual-poor type (2/83).The two moieties were all very small with "Y" shaped ureters and ectopic orifices.The last was the dual-well type (20/83).The upper moiety was almost the same size as the lower one,without apparent dilation of "Y" shaped or double ureters.Conclusion Based on kidney morphology,duplex kidney can be mainly classified into five types which can be depicted by CT urography prior to management and can provide an aid in selecting a successful course of surgical correction。

Abstract：Background Hybrid procedures including debranching of visceral and renal arteries followed by endovascular exclusion of the thoracoabdominal aortic aneurysm (TAAA) have recently been proposed as a less invasive alternative to conventional TAAA surgery.This study aimed to evaluate the immediate and long-term outcomes of hybrid procedures for TAAA in high-risk patients.Methods Between September 1998 and May 2012,32 high-risk TAAA patients (five females,median age 61.5 years)underwent hybrid procedures at a single institution.Simultaneous approach and staged approach were performed on the basis of patients' conditions.Follow-up computed tomography angiography (CTA) was routinely performed before discharge and at 6,12 months and annually thereafter.Results Procedural success was achieved in all cases.The median hospital stay was (21.5±2.3) days,and the median procedure time was (420±31) minutes.Blood loss averaged (2100±261) ml.A total of 124 visceral artery bypasses was performed.Two patients (6.3％) died within 30 days.One patient exhibited complete paraplegia (3.1％).The visceral graft patency was 96.1％ at 3 years.All-cause survival rates were 93.8％,87.5％,81.3％ and 53.1％ at 1,2,3 and 5 years,respectively.No patient died due to aortic events.The freedom rates from aortic events were 96.9％,93.6％,87.5％,68.8％ at 1,2,3 and 5 years,respectively.Conclusions The results of visceral hybrid repair for high-risk patients with complex TAAAs are encouraging.However,the procedure is still a significant physiological insult to patients.Until branched and fenestrated endovascular repair become more common,hybrid procedure will continue to have a role in high-risk patients。

Abstract：Background Despite outstanding antiplatelet properties of aspirin and clopidogrel,some patients taking these drugs continue to suffer complications.Antiplatelet resistance appears to be a new prognostic factor in acute coronary syndrome patients for clinical events associated with stent thrombosis (ST).However,there is no optimal method to identify it and assess its correlation to clinical outcomes.This study sought to evaluate the predictive value of antiplatelet resistance assessed by whole blood impedance aggregometry for the risk of early ST in patients with acute coronary syndrome who underwent coronary stenting.Methods Platelet responses to aspirin and clopidogrel in 86 patients with acute coronary syndrome were measured by whole blood impedance aggregometry.Spontaneous platelet aggregation was defined as antiplatelet resistance identified by the increased electrical impedance.The clinical endpoint was early stent thrombosis during 30-day follow-up after coronary stenting.Results The prevalence of aspirin resistance,clopidogrel resistance and dual resistance of combined clopidogrel and aspirin resistance were 19.8％,12.8％ and 5.8％ respectively.Diabetes,female and higher platelet counts were more frequently detected in clopidogrel-resistant and dual-resistant patients.During 30-day follow-up,the patients with clopidogrel resistance and dual resistance had higher incidence of early stent thrombosis (18.2％ vs.1.3％,40.0％ vs.1.2％,P ＜0.05).Binary Logistic Regression analysis indicated that dual resistance remained an independent predicator for early stent thrombosis (odds ratio 34.064,95％ CI 1.919-604.656,P=-0.016).Conclusions Antiplatelet resistance assessed by whole blood impedance aggregometry is paralleled to clinical events,and dual antiplatelet resistance is an independent predicator for early stent thrombosis in patients with acute coronary syndrome.As a physiological assessment of platelet reactivity,whole blood impedance aggregometry is a convenient and accurate option for measuring antiplatelet resistance and hence predicting early stent thrombosis.~L:--|~---~ I ~t'l~.4~ IA~.~ ~。

Abstract：Background Few literatures pertain to the 16S ribosomal DNA (16S rDNA) analysis of bacteria contributing to primary and persistent endodontic lesions,with no information available for the Chinese population.As such,we investigated endodontic bacteria associated with primary and persistent endodontic lesions in adult Chinese patients living in Beijing,China using 16S rDNA gene sequencing techniques.Methods Endodontic microbial samples were obtained from fourteen adult Chinese patients and subjected to DNA extraction.Pllymerase chain reaction (PCR) products were cloned and 100 clones from each generated library were randomly selected.Purified plasmid DNA with 16S rDNA gene inserts was sequenced,and the sequences were searched against GenBank databases using the BLASTN algorithm.Only significant identification with the highest-scored BLAST result and 99％ minimum similarity was considered for phylotyping.Results More than 150 taxa were obtained.Primary endodontic infection was mainly associated with Burkholderia cepacia,Actinomyces,Aranicola spp.and Streptococcus sanguinis,whilst Burkholderia cepacia was predominant in the persistent endodontic infections.Conclusion There is a difference in the species profile associated with endodontic infections of Chinese patients living in Beiiing in comoarison to other geographical or ethnic reports。

Abstract：Background T-lymphoma and metastasis gene 1 (Tiam1) produces a guanine nucleotide exchange factor (GNEF) that regulates guanosine triphosphatase,which transforms guanosine diphosphate to guanosine triphosphate.Recently published data indicate that Tiam1 was associated with gastric cancer.The aim of this study was to investigate biological effects and potential mechanisms of Tiam1 in gastric carcinoma.Methods We analyzed the expression of Tiam1 in 114 pair-matched gastric neoplastic and adjacent non-neoplastic tissues by quantitative real-time PCR.We investigated Tiam1 expression and its prognostic value for gastric cancer.Furthermore,the functions of Tiam1 over-expression were analyzed with stable-expression Tiam1 plasmid in human gastric cancer cell lines.Results Tiam1 expression was significantly associated with cell differentiation and lymphatic metastasis; expression of Tiam1 mRNA was up-regulated in gastric cancer compared to pair-matched adjacent non-tumor tissues.Analyses of surgical tissue samples and 5-year survival of gastric cancer patients showed that those with strong Tiam1 expression had significantly shorter overall survival time than those with negative Tiam1 expression.Ectopic expression of Tiam1 promoted cell growth,migration and invasion of gastric cancer cells in vitro.Conclusions In gastric cancer cells,Tiam1 affects multiple properties associated with acquisition of the metastatic phenotype,and may be a marker ofgastric cancer progression and metastasis in a subset of cancer。

Abstract：Background Some studies have shown that serum resistin levels increase in hypertensive patients.Whether the increase of resistin is related to inflammatory or vascular endothelial function is still unknown.We investigated the relationship of increased resistin levels to inflammatory factors and circulating biomarkers of vascular endothelial function in hypertensive patients.Methods One hundred and forty-four nondiabetic patients with new onset,hypertension were recruited.Blood pressure,blood glucose,insulin,resistin,tumour necrosis factor-α (TNF-α),interleukin-6 (IL-6),von Willebrand factor (vWF),endothelin-1 (ET-1) and nitric oxide (NO)were measured.The homeostasis model assessment,insulin resistance index (HOMA-IR) was calculated.Patients were divided into two groups according to the median level of resistin.Cytokine levels and indicators of vascular endothelial function were compared.Multiple linear regression was used to determine factors influencing resistin.Results Serum resistin ranged from 2.57 ng/ml to 20.18 ng/ml in hypertensive patients.High resistin group (＞8.36 ng/ml) had higher levels of TNF-α,IL-6,vWF and ET-1 but lower level of NO compared with low resistin group (P ＜0.01).Resistin was positively correlated with body mass index,systolic blood pressure,HOMA-IR,low-density lipoprotein cholesterol,TNF-α and ET-1 but negatively correlated with NO (all P ＜0.05).Multiple linear regression analysis revealed that HOMA-IR,TNF-α,NO and ET-1 are independent predictors of resistin with standardized regression coefficients of 0.625,0.368,-0.260 and 0.222,respectively (all P ＜0.01).Conclusions We conclude that higher resistin levels are associated with inflammatory activation and endothelial dysfunction,because patients with essential hypertension have increased TNF-α,IL-6,vWF and ET-1 and decreased NO.Moreover,the statistical association of resistin with TNF-α,NO and ET-1 suggests involvement of resistin in the progression of hypertension by influencing inflammation and endothelial function。

Abstract：Background Recognizing renal vascular variants preoperatively is important in order to avoid vascular complications during surgery.This study aimed to investigate the renal vascular variants with dual-energy computed tomography (DECT) angiography to provide valuable information for surgery.Methods A total of 378 patients underwent DECT.The number,size,course and relationships of the renal vessels were retrospectively observed from the scans.Anomalies of renal arteries and veins were recorded and classified.Multiplanar reformations (MPR),maximum intensity projections (MIP),and volume renderings (VR) were used for analysis.Results In 378 patients (756 kidneys),renal artery variations were discovered and recorded in 123 kidneys (16.3％,123/756) of 106 patients (28.0％,106/378).Type IB (early branches of the only one main renal artery) and IC (accessory renal artery with only one main renal artery) were found most frequently with an incidence of 11.4％ (43/378) and 14.5％(55/378).The incidence of renal artery variations in the left kidney was not statistically different than in the right kidney (12.4％ vs.11.1％).The incidence of renal vein variations was detected in 104 patients (27.5％,104/378).The incidence of venous variants in the right kidney was higher than in the left kidney (20.1％ vs.7.4％),but left renal vein variations were more complex.Variants of the left renal vein were detected in 28 patients including type 1 (circumaortic left renal vein) in eight cases,type 2 (retroaortic left renal vein) in seven cases,type 3 (abnormal reflux) in six cases,type 4 (late venous confluence of left renal vein) in five cases,and type 5 (rare type) in two cases.The frequency of left renal vein variation associated with the left renal accessory artery was significantly higher than with early branches of the left renal artery (P=0.037).Conclusions The renal vascular variants are rather common and complex.DECT angiography can demonstrate the precise anatomy of the renal vessels,which is a benefit for renal transplantation or other renal operations

Abstract：Background Oral squamous cell carcinoma (OSCC) is one of the most common malignancies in the oral and maxillofaoial region.Yes-associated protein 1 (YAP1) has been implicated as a bona fide oncogene in solid tumors.We seek to elucidate the role of YAP1 in OSCC tissue.Methods We identified YAP1 gene and protein overexpression in 30 OSCC patients and 10 normal oral mucosa tissues by immunohistochemistry,Western blotting and reverse transcription polymerase chain reaction (RT-PCR).Results In the normal oral mucosa by immunohistochemical staining,YAP1 mainly located in both the cytoplasm and nucleus mainly the nuclei of the basal cells.In OSCC,the expression of YAP1 translocated from the nucleus to cytoplasm;YAP1 being mainly located in both the cytoplasm and nucleus of the adjacent mucosa.The expression of YAP1 gradual increased in normal oral mucosa,tumor adjacent mucosa and low grade,middle grade,high grade OSCC tissue by Western blotting.Significant difference was found between the expressions of the normal oral mucosa and OSCC tissue (P ＜0.05).The coincidence was detected between the normal oral mucosa and OSCC tissue by RT-PCR (P ＜0.05).Conclusions YAP1 is involved in the carcinogenesis and development of OSCC.There is a transformation between nucleus and cytoplasm。

Abstract：Background The specificity and precision of lymphadenopathy assessment using US,CT and MRI are generally unsatisfactory,while fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) can support this process by providing additional information about the lymph node features.However,which image features of 18F-FDG PET/CT play the key role in the diagnosis and cutoffs of malignant cervical lymphadenopathy still needs to be determined by further studies.Our study aimed to identify 18F-FDG PET/CT abnormalities that would assist in making a reliable diagnosis of malignant cervical lymphadenopathy in enlarged cervical lymph nodes of patients with unknown primary diseases.Methods One hundred and ninety-one consecutive patients of cervical lymphadenopathy with unknown primary causes were examined by 18F-FDG PET/CT from May 2007 to October 2011 and a definite diagnosis was established by pathologic biopsy.18F-FDG PET/CT images were evaluated to identify the relevant abnormalities.All image features were analyzed by optimal scale regression tests to determine the important factors that were predictive for the diagnosis of malignant cervical lymphadenopathy and the cutoffs.Results The factors studied in 18F-FDG PET/CT images for predicting malignant cervical lymphadenopathy were sex,age,node location,size,shape,margins,maximum standard uptake value (SUV),mean SUV,FDG uptake pattern and number of nodes.It was found that mean SUV,maximum SUV,FDG uptake pattern,location,size and margins were the important risk factors of cervical lymph nodes that could predict malignant cervical lymphadenopathy.Signs of mean SUV≥2.5 (or maximum SUV≥3.5),nodular FDG uptake pattern,location of ⅡA,Ⅲ,Ⅳ,ⅤB,Ⅵ and Ⅶ regions,size≥1.5 cm and vague margins had their optimal diagnostic accuracy (Ac) and Youden index (YI),further,combination of any three factors of these six important risk factors would led to the best diagnosticAc of 96％ and YI of 0.93.Conclusions Signs of mean SUV,maximum SUV,FDG uptake pattern,location,size and margins of node in 18F-FDG PET/CT imaging are important predictive factors of malignant cervical lymphadenopathy.A combination of multiple factors may yield a higher diagnostic efficacy。

Abstract：Background Some studies suggested that human papillomavirus (HPV) infection could reduce the clinical pregnancy rate and double the spontaneous abortion rate compared with non-infected women after in-vitro fertilization and embryo transfer (IVF-ET).But some other studies showed there was no difference between HPV infected and non-infected groups of ART outcomes.The role of HPV infection in infertile women undergoing IVF treatments has been a controversial issue which this article attempts to investigate.Methods This is a retrospective analysis of 3880 infertile women undergoing IVF treatment at Peking University Third hospital reproductive medical center in 2008.Patients with abnormal thin-layer preparation cytologic test (TCT) results who underwent fresh cycle embryo transfer were divided into an HPV positive group (n=56) and an HPV negative group (n=56).The clinical parameters were compared (using Student's t-test and chi-squared test).Univariate and multivariate analyses were taken to see if HPV infection affects the clinical pregnancy rate.Results Of the 3880 cases 157 had TCT abnormality (4.0％).Of the 149 patients who had HPVtest results,112 women (81.2％) received a fresh cycle embryo transfer.Each group had 56 cases.The patients were of similar age and BMI,basic hormone levels,and infertile factors were similar.The gonadotropin use,oocyte retrieval number,clinical pregnancy rate,abortion rate and newborn condition were all similar between groups.Analyses showed neither HPV infection nor HPV hybrid capture (HC) Ⅱ results affected clinical pregnancy rate after IVF treatments,but the FSH level did.Conclusion HPV positivity did not appear to impact assisted reproductive technology (ART) success."Extensive treatment" for HPV before IVF was not recommended because treatment time will increase age and reduce ovarian function,which will lead to inferior IVF outcomes。

Abstract：Background Anterior capsular contraction syndrome is a potential complication of continuous curvilinear capsulorhexis (CCC).Three neodymium:yttrium-aluminum-garnet (Nd:YAG) laser relaxing incisions decrease anterior capsular contraction but the mechanism is unknown.The present study analyzed the biomechanical mechanism of three Nd:YAG laser relaxing incisions made to reduce anterior capsular contraction.Methods A three-dimensional control model and a three-dimensional Nd:YAG model of the anterior capsule with an opening diameter of 6 mm were created.Three incisions of 1 mm in length were made centrifugally at intervals of 120° around the opening circle.The stress alterations of the anterior capsule after CCC with and without Nd:YAG relaxation were numerically simulated and compared.Results In the control model,the stress was axially uniform in the inner area and relatively high near the inner rim of the opening.Meanwhile,in the Nd:YAG model,the stress level was very low in the inner opening areas,especially near the three incisions.The relaxing incisions in the Nd:YAG model significantly released the relatively high stress on the anterior capsule.Additionally,there was a high stress gradient near the relaxing incisions.Conclusion Biomechanical effects of stress release may be the preventive mechanism of Nd:YAG incision against anterior capsular contraction syndrome。

Abstract：Background Post-resuscitation myocardial dysfunction has been implicated as a major cause of fatal outcome in patients who survive initially successful cardiopulmonary resuscitation (CPR).In our previous study,we found that impaired myocardial β-adrenergic receptor (AR) signaling is a key mechanism in post-resuscitation myocardial dysfunction and Shen-Fu injection (SFI) can attenuate post-resuscitation myocardial dysfunction.However,whether SFI can prevent impaired post-resuscitation myocardial β-AR signaling is not yet known.In this study,we investigated the effect of SFI on impaired myocardial β-AR signaling occurring post-resuscitation in a porcine model of cardiac arrest.Methods Ventricular fibrillation was induced electrically in anesthetized male landrace domestic pigs.After 4 minutes of untreated ventricular fibrillation,cardiopulmonary resuscitation was initiated.Sixteen successfully resuscitated pigs were randomized to receive a continuous infusion of either SFI (0.5 ml/min; n=8) or saline (placebo; n=8) for 6 hours,beginning 15 minutes after the return of spontaneous circulation (ROSC).Hemodynamic and echocardiographic data were recorded.β-AR signaling was assessed at 6 hours after the intervention by measuring myocardial adenylate cyclase activity,β-AR density and β-AR kinase expression.Results Treatment with SFI produced better maximum rate of left ventricular pressure increase (dp/dtrmax) and maximum rate of left ventricular pressure decline (-dp/dtmax),cardiac output,and ejection fraction after ROSC.SFI treatment was also associated with lower myocardial β-adrenergic receptor kinase expression,whereas basal and isoproterenolstimulated adenylate cyclase activity and the total β-AR density were significantly increased in the SFI group when compared with the placebo group.Conclusion SFI attenuated post-resuscitation myocardial dysfunction by preventing impaired myocardialβ-AR signaling after CPR。

Abstract：Background 5α-Reductase inhibitors (5α-RI) act by inhibiting the conversion of testosterone to dihydrotestosterone (DHT),thereby preventing DHT induced benign prostatic hyperplasia.The existing 5α-RIs can be classified into two types:competitive and noncompetitive.Currently,limited evidence is available concerning the effect differences between the two types of 5α-RI on androgens.The purpose of this study was to assess the effects of competitive and noncompetitive 5α-RIs on serum and intra-prostatic androgens in beagle dogs.Methods Twenty beagles with spontaneous benign prostatic hyperplasia were randomly allocated into two groups:epristeride group (n=10) in which beagles were treated with epristeride at 1 mg/kg once a day for 3 months,and finasteride group (n=10) in which beagles were treated with finasteride at 1 mg/kg once a day for 3 months.The levels of intra-prostatic testosterone and DHT were measured before treatment and on day one after three months medication.Serum levels of testosterone and DHT were measured at the same time points.Changes in androgen levels before and after treatment were analyzed,and comparisons were made within each treatment group and between treatment groups.Results After 3-month treatment,serum and intra-prostatic DHT levels all decreased significantly in both the epristeride and finasteride groups.The change of DHT in serum was significantly higher in the finasteride group (-14％ and-43％ in epristeride and finasteride groups respectively,with P＜0.001); however there was no significant difference in the changes of intra-prostatic DHT between the two groups (-47％ and-51％ in epristeride and finasteride groups,respectively,P=0.304).The decreases in DHT levels were accompanied by reciprocal increases in serum and intra-prostatic testosterone levels.Changes of testosterone were significantly higher in finasteride group both in serum (20％ and 42％in epristeride and finasteride groups,respectively,P＜0.001) and in prostate tissue (18％ and 29％ in epristeride and finasteride groups,respectively,P=0.004).Conclusions Two types of 5α-RI have similar effects in reducing DHT in prostate tissue in beagles.Competitive 5α-RI may reduce serum DHT to a greater scale,and significantly increase testosterone in beagle serum and prostate。

Abstract：Background Retinoic acid (RA) is a potent signaling molecule that plays pleiotropic roles in patterning,morphogenesis,and organogenesis during embryonic development.The synthesis from retinol (vitamin A) to retinoic acid requires two sequential oxidative steps.The first step involves the oxidation of retinol to retinal through the action of retinol dehydrogenases.Retinol dehydrogenases1l (RDH1l) is a novel zebrafish retinol dehydrogenase.Herein we investigated the role of zebrafish RDH1l in heart development and cardiac performance in detail.Methods RDH1l specific morpholino was used to reduce the function of RDH1l in zebrafish.The gene expressions were observed by using whole mount in situ hybridization.Heart rates were observed and recorded under the microscope from 24 to 72 hours post fertilization (hpf).The cardiac performance was analyzed by measuring ventricular shortening fraction (VSF).Results The knock-down of RDH1l led to abnormal neural crest cells migration and reduced numbers of neural crest cells in RDH1l morphant embryos.The reduced numbers of cardiac neural crest cells also can be seen in RDH1l morphant embryos.Furthermore,the morpholino-mediated knock-down of RDH1l resulted in the abnormal heart loop.The left-right determining genes expression pattern was altered in RDH1l morphant embryos.The impaired cardiac performance was observed in RDH1l morphant embryos.Taken together,these data demonstrate that RDH1l is essential for the heart development and cardiac performance in zebrafish.Conclusions RDH1l plays a important role in the neural crest cells development,and then ultimately affects the heart loop and cardiac performance.These results show for the first time that an enzyme involved in the retinol to retinaldehyde conversion participate in the heart development and cardiac performance in zebrafish。

The approval of imatinib in 2001 has changed the landscape of CML management.1-3 With its excellent efficacy in the International Randomized Study of Interferon and STI571 (IRIS),imatinib has become the standard of care for newly diagnosed patients.This change challenges the previous role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in CML treatment.However,allo-HSCT still plays an important role in the treatment of CML patients because of the following reasons:(1) up to one-third of patients in the first chronic phase (CP1) of CML (CML-CP1) are resistant to or intolerant of imatinib therapy;4,5 (2)patients with the T315I mutation are highly resistant to all tyrosine kinase inhibitors (TKIs);(3) pediatric and young patients with an identical sibling donor have a strong willingness to be cured;(4) patients with advanced disease have poor response to TKIs;and (5) the outcomes of HSCT have improved in recent years.So in this era,the indication was more complex and stratified in more detail,based on weighing the disease related risk and SCT related risk。

In 1936,Himworth first investigated insulin resistance and non-insulin resistance in diabetes.Then the terminology "type 1 diabetes (T1D)" and "type 2 diabetes (T2D)" were first used in 1951.In 1999,the World Health Organization (WHO) announced the classification of diabetes:as we all known,T1D and T2D.1 This classification is widely accepted and used.However,in clinical practice,it is quite often to find some patients cannot be simply diagnosed as T1D or T2D。

Chordoid meningioma (CM),characterized by its resemblance to chordoma,was first described by Kepes et al1 in 1988,and classified histologically as a WHO grade Ⅱ neoplasm in the 2000 revision of the WHO grading system,featured by its aggressive clinical course,great risk of recurrence,and infrequent association with hematological conditions.2 This article describes the clinical course,radiological characteristics,postoperative treatment,and prognosis of 17 patients with CM who underwent surgical treatment at our hospital。

Ectopic hamartomatous thymoma (EHT) is a very rare benign neoplasm.The histogenesis of EHT remains unclear.It was firstly described by Smith et al1 in 1982and was named EHT by Rosai et al2 in 1984.Since then dozens of cases have been reported.We herein report one case of EHT,describing the magnetic resonance (MR) findings correlated with its clinicopathological features,and reviewed literatures. A 31-year-old man presented with subcutaneous mass on the right supraclavicular area.It had been found six years previously and had shown signs of enlargement in resent four years.The size of mass palpated was about 6 cm × 8cm × 5 cm,and the margin was distinct.The mass was tough and movable,and did not move with the swallow。

To the editor:We found two small bowel diseases discovered by computed tomography enterography (CTE) and omitted by small bowel endoscopy.The two patients were both found obscure gastrointestinal bleeding in our hospital.One was found a small bowel stromal tumor,CTE findings mainly characterized by congested tumor without obstruction,with calcification spots in the tumor,and with obvious thickening of the feeding artery and draining vein and obvious edema of the intestinal wall (Figure 1A).Another was an arterial-venous malformation,CTE showing abnormal thickening of vessels in the intestinal wall in the arterial phase (Figure 1B).The lesions of these two cases were in the bordering parts of the jejunoileum。