Has the time come for another breakthrough in surgical myocardial revascularization?

Surgical myocardial revascularization has completed its fourth successful decade following the world＇s first clinical trial on coronary artery bypass grafting （CABG） in May 1967. Being one of the most popular and best investigated procedures in the history of surgery, CABG has stood the test of time with excellent results as measured by a variety of outcome markers. Even with the recent progress in percutaneous coronary intervention （PCI） and rapid development of intra-coronary stents （including drug-eluting stents）, the advantage of CABG over PCI is likely to continue in the foreseeable future.     

Management of solid renal tumour associated with von Hippel-Lindau disease

Von Hippel-Lindau （VHL） disease is a rare autosomal dominant disorder caused by germ line mutations of the VHL tumour suppressor gene. it predisposes affected individuals to develop a variety of neoplasms, including haemangioblastomas of the central nervous system, retinal angiomas, renal cell carcinomas （RCCs）, pheochromocytomas and cysts of the kidneys and epididymis. Germ line VHL mutations have been found in all VHL disease families. RCC occurs in 25% to 45% of patients with VHL disease and is one of the leading causes of death.[第一段]     

Effects of minimal lipopolysaccharide-instilled lungs on ventilator-induced lung injury in rats

Mechanical ventilation （MV） may aggravate lung injury induced by a variety of injuries, including intratracheal hydrochloric acid instillation, intratracheal lipopolysaccharide （LPS） instillation with or without concurrent saline lavage, intravenous LPS, or intravenous oleic acid. However, the mechanism for this detrimental effect of MV is unclear. The purpose of the present study was to determine the effect of MV on lung injury induced by minimal LPS-instillation and on the LPS receptor CD14 in the lung.     

Prenatal diagnosis of fetal aortopulmonary septal defect with ventricular septal defect by two-dimension echocardiography

Fetal aortopulmonary septal defect （APSD） is an extremely rare condition, accounting for 0.1%-0.2% of all cardiac defects in live births world wide. Hospital mortality is 13% and 33% for simple and complex APSD,respectively. This rare cardiac defect refers to a congenital malformation in the development of the arteriosus truncus septum, and is usually associated with a wide variety of other structural cardiac anomalies such as ventricular septal defect （VSD）, pulmonary valve stegnosis and so on. Prenatal diagnosis of an APSD is possible by echocardiography. In relevant literature, only two cases, which were diagnosed initially by prenatal echocardiography, have been reported.     

Relationship between intravascular ultrasound imaging features of coronary plaques and soluble CD105 level in patients with coronary heart disease

Plaque rupture with subsequent thrombus formation is the common pathophysiological substrate of acute coronary syndrome （ACS）. Moreno et al reported mat neovascularization as manifested by the localized appearance of microvessels is increased in ruptured plaques in the human aorta. Microvessel density is also increased in inflammatory lesions, with intraplaque hemorrhage and in thin-cap fibroatheromas. Microvessels at the base of the plaque are independently correlated with plaque rupture, suggesting a contributory role for neovascularization in the process of plaque rupture. Soluble CD105, a sensitive serum marker of neovascularization, is thought to be associated with cardiovascular disease. The purpose of this study was to assess the relationship between the level of soluble CD105 and the morphological plaques by intravascular ultrasound （IVUS） in patients with stable angina （SA） and those with unstable angina （UA） and whether soluble CD105 may serve as a non-invasive marker of coronary plaque destabilization.     

Tbx1 regulates the development of zebrafish neural crest cells by retinoic acid signaling

The TBX1 gene is considered to be the most important gene in the aetiology of DiGeorge syndrome （DGS）.DGS is a human disorder characterised by a number of phenotypic features involving abnormal development of pharyngeal arches, facial dysmorphogenesis and cardiac outflow tract anomalies. Retinoic acid （RA） deficiency also produces DGS-like phenotypes. The affectd tissues in DGS are derivatives of neural crest cells （NCCs）, which originate from the border between the neural plate and non-neural ectoderm, migrate to specific destinations in the body, and generate a variety of derivatives. In our study, we have explored the hypothesis that tbxl affects NCC development in zebrafish by regulating RA signaling.     

Mechanical ventilation in acute respiratory distress syndrome: past, present and future

Acute respiratory distress syndrome （ARDS） is a life threatening respiratory failure due to lung injury from a variety of precipitants.Mechanical ventilation （MV） is the foundation in the supportive management of patients with ARDS.1 However,it is associated with several complications,such as increased risk of pneumonia and development of lung injury.The improved understanding of ARDS and complications from MV has been considered important in designing lung-protective ventilatory strategies aimed at attenuating or preventing organ dysfunction and improving outcomes.     

Expression of suppressor of cytokine signaling 1 in the peripheral blood of patients with idiopathic pulmonary fibrosis

Background Idiopathic pulmonary fibrosis （IPF） is a progressive diffuse parenchymal disease with a poor prognosis.A variety of cytokines and chemokines are involved in its pathophysiology.The aim of this study was to evaluate the clinical features in IPF patients with the expression of suppressor of cytokine signaling 1 （SOCS-1）,which acts as a negative regulator of cytokine signaling.Methods IPF patients （n=20） and healthy controls （n=16） were included in this study.The expression of SOCS-1 was analyzed in peripheral blood mononuclear cells （PBMC） of subjects using RT-PCR.Interleukin 4 （IL-4）,transforming growth factor β1 （TGF-β1） and type Ⅰ collagen expression were also analyzed in each individual using enzyme-linked immunosorbent assay （ELISA）.The clinical characteristics of IPF patients were delineated.These results were analyzed by SPSS13.0 statistics software.Results SOCS-1 mRNA expression was significantly decreased in the PBMC of IPF patients compared with healthy controls; serum levels of IL-4 and TGF-β1 were higher in IPF patients.The patients with lower expression of SOCS-1 developed lower percentage of forced vital capacity （FVC%） and DLCO/VA.A patients＇ SOCS-1 mRNA level was negatively correlated with serum levels of IL-4,and negatively correlated with their high-resolution computed tomography （HRCT） scores.Conclusions SOCS-1 mRNA can be detected in PBMC,and it is down-regulated in IPF patients.The expression of SOCS-1 is associated with the severity of IPF patients＇ symptoms,so it might be the predictor of disease severity.SOCS-1 might play an important role in IPF by reducing the expression of the T helper type 2 （Th2） cell-related cytokine IL-4.     

Infertility Management in Men with Cystic Fibrosis

Cystic fibrosis （CF） is a multisystem autosomal recessive disorder. CF has a reported incidence of 1 in 2 500 and a carrier frequency of 1 in 25. It is caused by mutations in a gene located on the long arm of chromosome 7. With almost 50% of patients with CF now in the adult population, and a very high interest in future parenting （78% of men wanting children）, there is an increasing need to be proactive in terms of advice about reproductive health. Discussion on reproduction should start in early adolescence and be regularly updated by medical staff. The recent advances in reproductive techniques have allowed the development of sperm aspiration coupled with intra-cytoplasmic sperm injection （ICSI）. Spermatozoa can be retrieved from either the epididymis or the testes. Genetic counselling is strongly recommended for both partners when congenital bilateral aplasia of vas deferens （CBAVD） is diagnosed as there is the inevitability of transmitting a mutated CFTR gene, and an increased risk of producing an affected child with serious long-term implications. Most treatment centres, with the introduction of ICSI, routinely screen all males with azoospermia caused by obstruction （other than that caused by vasectomy） or germ cell failure. Protocols usually involve screening for 28 relatively common CFTR mutations. Further advanced testing may be necessary up to a final detection level of approximately 98.5%. Before considering any assisted reproduction treatment, it is pertinent that CF patients receive medical and psychological counselling.     

Age, estimated glomerular filtration rate and ejection fraction score predicts contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease: insight from the TRACK-D study

Background The occurrence of contrast induced acute kidney injury （CIAKI） has a pronounced impact on morbidity and mortality.The aim of the present study was to appraise the diagnostic efficacy of age,estimated glomerular filtration rate （eGFR） and ejection fraction （AGEF） score （age/EF（％）＋1 （if eGFR was ＜60 ml·min-1·1.73 m2）） as an predictor of CIAKI in patients with diabetes mellitus （DM） and concomitant chronic kidney disease （CKD）.Methods The AGEF score was calculated for 2 998 patients with type 2 DM and concomitant CKD who had undergone coronary/peripheral arterial angiography.CIAKI was defined as an increase in sCr concentration of 0.5 mg/dl （44.2 mmol/L） or 25％ above baseline at 72 hours after exposure to the contrast medium.Post hoc analysis was performed by stratifying the rate of CIAKI according to AGEF score tertiles.The diagnostic efficacy of the AGEF score for predicting CIAKI was evaluated with receiver operating characteristic （ROC） analysis.Results The AGEF score ranged from 0.49 to 3.09.The AGEF score tertiles were defined as follows：AGEFlow ≤0.92 （n=1 006）; 0.92 ＜AGEFmid ≤1.16 （n=1 000）,and ACEFhigh ＞1.16 （n=992）.The incidence of CIAKI was significantly different in patients with low,middle and high AGEF scores （AGEFlow=1.1％,AGEFmid=2.3％ and AGEFhigh=5.8％,P ＜0.001）.By multivariate analysis,AGEF score was an independent predictor of CIAKI （odds ratio=4.96,95％ CI：2.32-10.58,P ＜0.01）.ROC analysis showed that the area under the curve was 0.70 （95％ CI：0.648-0.753,P ＜0.001）.Conclusion The AGEF score is effective for stratifying risk of CIAKI in patients with DM and CKD undergoing coronary/peripheral arterial angiography.     

Pharmacological intervention of hypertension in proteinuric chronic kidney disease： how and what？

Chronic kidney disease （CKD） is a significant interactive disease in patients with diabetes, hypertension, and cardiovascular disease with major morbidity consequences and high costs to the healthcare system. The prevalence of end stage renal disease （ESRD）, a f＇mal outcome of CKD, has increased progressively in the past decades in both developing and developed countries. It is now appreciated that the majority of patients with CKD have a chronic decline of renal function over years before renal replacement therapy is required. This non-specific process continues even when the initial insult is no longer present and has been called progression of CKD.     

Effect of uric-acid-lowering therapy on progression of chronic kidney disease: A meta-analysis

The efficacy and safety of uric-acid-lowering therapy （UALT） on slowing the progression of chronic kidney disease （CKD） accompanied by hyperuricemia were assessed. We searched Cochrane Library, PubMed, EMbase, CNKI, Wanfang and Vip databases up to November 15, 2012 for randomized controlled trials （RCTs） which compared the effect of UALT to control therapy in hyperuricemic patients secondary to CKD, and then performed quality evaluation and meta-analysis on the included studies. Seven RCTs involving 451 cases were included. UALT delayed the increase of serum creatinine （MD=-62.55 μol/L, 95% CI： -98.10 to -26.99） and blood urea nitrogen （MD= -6.15 mmol/L, 95% CI -8.17 to -4.13） as well as the decrease of glomerular filtration rate [MD=5.65 mL/（min.l.73 m2）, 95% CI： 1.88 to 9.41], decreased systolic blood pressure （SBP） （MD= -6.08 mmHg, 95% CI： -11.67 to -0.49）, and reduced the risk of the renal disease progression （RR=0.30, 95% CI： 0.19 to 0.46）. However, there was no statistically significant difference in 24-h urinary protein quantity and diastolic blood pressure （P〉0.05）. We identified that UALT could delay the progression of CKD with secondary hyperuricemia. And this also indirectly proved that hyperuricemia was a risk factor for the CKD progression.     

Single nucleotide polymorphisms in the D-loop region of mitochondrial DNA and age-at-onset of patients with chronic kidney disease

Background The mitochondrial displacement loop （D-loop） accumulates mutations and single nucleotide polymorphisms （SNPs） at a higher frequency than other regions of mitochondrial DNA （mtDNA）.We previously identified disease riskassociated SNPs in the D-loop of chronic kidney disease （CKD） patients; in this study,we investigated the association of age-at-onset and D-loop SNPs in CKD patients.Methods The D-loop region of mtDNA was sequenced in 119 CKD patients attending the Fourth Hospital of Hebei Medical University between 2002 and 2008.The age-at-onset curve of the CKD patients was calculated using the KaplanMeier method at each SNP site,and compared using the log-rank test.Results The mean age of 119 CKD patients was （55.6±14.2） years,and 56.3% were males.The mean estimated glomerular filtration rate （eGFR） was （81.2±12.4） ml·min^-1·1.73 m^-2,with 79.8% （n=95） of patients having an eGFR 〈60 ml·min^-1·1.73 m^-2.All participants had an eGFR 〉30 ml·min^-1·1.73 m^-2.The age-at-onset for CKD patients who smoked was significantly lower than that of non-smoking CKD patients.The SNP sites of nucleotides 150C/T were identified for their association with age-at-onset using the log-rank test.The age-at-onset of patients with the minor allele T genotype was significantly lower than that of patients with the C genotype at the 150 SNP site （P=0.010）.Conclusions Genetic polymorphisms in the D-loop appear to be predictive markers for age-at-onset in CKD patients.Accordingly,the analysis of genetic polymorphisms in the mitochondrial D-loop may help identify CKD patient subgroups at high risk of early onset disease.     

Kidney salvage by catheter guided thrombolysis in acute renal artery thromboembolic occlusions

Acute renal artery occlusion （ARAO） is a rare clinical entity. Typical clinical presentations of ARAO are non-specific and include acute lumbar or abdominal pain coexisting with nausea, vomiting and fever. Peripheral emboli are the major cause of ARAO, predominantly arising from cardiac diseases. Other, relatively frequent causes of ARAO include atherosclerosis, trauma, dissection or renal artery aneurysms.     

谭新华教授辨治精囊炎经验

谭新华,教授,主任医师,博士研究生导师,享受国务院政府特殊津贴专家,湖南省名中医,全国首批、第三批老中医药专家学术经验继承工作指导老师。从事中医医疗、教学、科研工作50余年。治学重理论与实践结合,衷中参西;倡笃学务实,法古纳新;医德高尚、医术精湛,擅长外科疑难杂病的诊治,尤其对男科疾病的中医药诊治有较深研究和造诣。精囊炎是男性较常见的感染性疾病之一,病因病机复杂,缠绵难愈,谭师对于精囊炎的诊疗,疗效卓著,现将其诊疗经验介绍如下。     

表皮生长因子受体酪氨酸激酶抑制剂在非小细胞肺癌应用的瓶颈——获得性耐药

以表皮生长因子受体酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosine kinase inhibitor，EGFR-TKI）分子靶向治疗研究为肇始，转化性研究使基础实验和临床实践间的鸿沟迅速填平，改变着人们认识治疗肺癌的视角。无可否认，EGFR-TKI上市后极大地延伸了肿瘤学家治疗肺癌的手段，但不管从临床经验、临床研究数据、分子生物学层面还是文献计量学的角度，     

益智健脑颗粒联合针灸对阿尔茨海默病大鼠学习记忆的影响

目的观察益智健脑颗粒联合针灸对阿尔茨海默病（Alzheimers disease,AD）大鼠学习记忆的影响。方法将大鼠随机分为假手术组（A组）、模型组（B组）、针灸组（C组）、益智＋针灸组（D组）各10只,B、C、D 3组分别以海马CA1区注射β淀粉样蛋白25-35（Aβ25-35）造模,A组注射等量的双蒸水,各组分别治疗20 d后行Morris水迷宫试验,观察大鼠学习记忆能力变化。结果B组较A组的平均潜伏期明显延长,差异具有统计学意义（P〈0.05）;与B组比较,C组、D组的平均潜伏期明显缩短,过台次数增多,差异具有统计学意义（P〈0.05,P〈0.01）;与C组比较,D组的潜伏期缩短,过台次数增多,差异具有统计学意义（P〈0.05）。结论益智健脑颗粒联合针灸能够提高Aβ25-35介导的AD模型大鼠的学习记忆能力。     

New Mechanism of Herb-herb Interaction between Ginseng and Trogopterus Based on CYPs in Rat Livers

The study was designed to investigate the potential mechanism of herb-herb interaction between ginseng and Trogopterus （Trg） based on Cytochrome P450 isozymes （CYPs） in rat livers. We estimated the influence on CYP1A2, CYP2E1, and CYP3A1/2 activity caused by ginseng and Trg used in combination. The CYP1A2 and CYP2E1 enzyme activity were induced by ginseng and Trg used in combination. And this induction effect was caused via inducing CYP1A2 and CYP2E1 protein expression which was supposed caused by inducing the gene expression of CYP1A2 and CYP2E1.     

中医疗法治疗运动性疲劳的研究进展

随着竞技体育的发展，运动员经常承受着大负荷、超强度的体力训练，因此极易产生运动性疲劳。疲劳的出现使肌内压增高，局部缺血，造成氧化代谢、H^＋排出率与pH值降低，血乳酸增高，从而影响肌纤维神经传导速度和肌内收缩力量，减弱了肌肉保护能力。致使较多的冲击力传到骨骼上，故易导致疲劳骨折的发生,严重影响了运动员的训练和比赛成绩，对运动员身心产生不必要的伤害。运动性疲劳消除手段的研究一直是竞技体育工作和运动医学关注和研究的焦点。