Lower Extremity Arterial Occlusive Disease As a Rare Complication of Crohn's Disease

Objective To investigate the clinical characteristics and treatment strategy of lower extremity arterial occlusive disease in patients with Crohn＇s disease （CD）. Methods Clinical information of 9 cases suffering from lower extremity arterial occlusion and CD was investigated retrospectively. Results All the cases were less than 50 years old and the most were females （8/9）. Arterial occlusions occurred in either active （5/9） or inactive （4/9） stage of CD. Besides the arteries of lower extremities, other arteries could also be involved such as aorta, iliac artery, renal artery or mesentery artery. Seven cases had atherosclerotic imaging findings （4 had aortic plaques and 6 had iliac artery stenoses）. Embolectomy or thromboendarterectomy were mostly performed. Four （44.4%） cases had recurrent lower limb ischemia. Conclusions Arterial occlusive disease is a rare extraintestinal manifestation of CD. A thorough inspection of aorta is necessary. Embolectomy is mostly preferred. Anticoagulation treatment is highly recommended after the operation.     

Twelve years’ experience and clinical results of using the radial artery for coronary revascularization

Background The radial artery （RA） is becoming a popular conduit for coronary artery bypass grafting （CABG）,yet data reporting the long-term results are rare.We reported our clinical,angiographic and intravascular ultrasound findings on 93 patients who had the RA used as part of the conduit for the CABG procedures during a 12-year period from June 2001 to June 2013.Methods A total of 118 radial artery conduits were harvested in 87 males and 6 females,age from 28 to 66 （mean 49.9） years.An ＂intra-operative Allen＇s test＂ was developed to safeguard blood supply to the arm and hand.A ＂double-clip ＆ scissors-cut＂ technique was carried out to minimize the thermal injury to the radial artery from the diathermy.The left radial artery was used in 67 patients,the right in one,and bilateral radial arteries in 25 patients.One hundred and twenty-two out of 272 distal anastomoses （44.9％） were constructed with radial arteries,with an average of 2.9 grafts per patient （range 2-6）.Results Follow-up angiography and intravascular ultrasound study at 3-139 postoperative months （mean 59 months） revealed a 93.1％ RA patency.String sign occurred in one patient in whom the RA was directed to a big right coronary artery with a stenosis of around 50％.The patency for the internal mammary artery was 96.4％.Conclusions The RA is an excellent conduit that broadens the options for total arterial CABG surgery.Good graft patency could be achieved through careful harvesting techniques and choice of proper target coronary vessels.     

Effects of low doses of aerosolized iloprost combined with tadalafil in treatment of adult congenital heart disease with severe pulmonary arterial hypertension

Pulmonary arterial hypertension （PAH） is a common and serious complication of congenital heart disease （CHD）.Many studies have confirmed that the prostacyclin analogues,5-phosphodiesterase （PDE-5） inhibitors,and endothelin receptor antagonists,were safe and effective in the treatment for PAH due to CHD.1,2 But whether the combination of targeted PAH therapy drugs provides similar synergistic effects is still controversial.1,2 Therefore,we investigated whether adult patients with severe PAH secondary to CHD would benefit from iloprost combined with low-dose tadalafil.     

Association of chronic obstructive pulmonary disease with coronary artery disease

Background The relationship between chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) remains largely unknown.This study aimed to explore the association of COPD with CAD,e...     

Risk factors for perioperative major cardiac events in Chinese elderly patients with coronary heart disease undergoing noncardiac surgery

Background Few studies have investigated perioperative major adverse cardiac events (MACEs) in elderly Chinese patients with coronary heart disease (CHD) undergoing noncardiac surgery.This study examin...     

Late intra-atrial reentrant tachycardia would be prevented by ablation of right atrial potential isthmuses during the surgical operation for congenital heart disease

Intra-atrial reentrant tachycardia （IART） is not uncommon after surgical correction of congenital heart disease （CHD）. The patients with IART are often refractory to antiarrhymic agents and present with severe symptoms. Current treatment approach to IART has shifted largely to interventional procedures which have a good short-term success rate, however, late recurrence rate is still high. With the development of mapping technique especially the application of three-dimensional electroanatomic mapping,     

Prevention and treatment of viral respiratory infections by traditional Chinese herbs

Objective This review focuses on current knowledge of traditional Chinese herbs on prevention and treatment of viral respiratory infections,especially caused by Severe Acute Respiratory Syndromes （SARS） virus,respiratory syncytial virus （RSV） and influenza viruses.Data sources The data used in this review were obtained from PubMed and CNKI up to May 2013.Terms of Chinese herbs and infections of respiratory tract were used in the search.Study selection Articles related that Chinese herbs preventing and treating infections in respiratory tract were retrieved and reviewed.The risk of bias of included studies was assessed by the method in the ＂Cochrane Handbook of Systematic Reveiws of Interventionsand studies＂ with high risk of bias were excluded.Four criteria for selections were set as following：randomized controlled trial,particular effective compound or derivative,reproducible result and animal test.Results Infectious respiratory tract diseases cause most mortality among infectious illnesses around the world.As traditional medicines,Chinese herbs have been widely used to deal with diseases for centuries and have been proved effective in practice.The administration of some Chinese herbs stimulates,suppresses or regulates the activity of immune system,thus protecting the respiratory tract or relieving infections of pathogens.Many herbs have remarkable antiviral effects,therefore they are used as substitutes of antimicrobial drugs.Based on the theory of traditional Chinese medicine,mix-using herbs provide a synergistic benefit on preventing and healing respiratory tract infections.Many commercial herbal medicines containing one or more compounds have been successfully applied to prevent and treat viral infections of respiratory tract clinically.Conclusions Traditional Chinese herbs could directly inhibit pathogens infecting respiratory tract,or coordinate the activity of immune system to avoid or relieve infections.With the emergence of antidrug pathogens or new variants,Chinese herbs.give strong evidence to protect human health.     

Potential biomarkers predicting risk of pulmonary hypertension in congenital heart disease: the role of homocysteine and hydrogen sulfide

Background Pulmonary hypertension （PH） is a common complication of congenital heart disease （CHD）.Although risk stratification is vital for prognosis and therapeutic guidance,the need for understanding the role of novel biomarkers cannot be overlooked.The aim of the present study was to investigate the changes of homocysteine and hydrogen sulfide levels and find potential biomarkers for early detection and treatment.Methods Between September 2012 and April 2013,we prospectively collected data on 158 pediatric patients with left to right shunt CHD at our institution.Standard right heart catheterizations were performed in all cases.Seventy-seven cases were associated with PH.The levels of homocysteine and hydrogen sulfide were detected with fluorescence polarization immunoassay and a sensitive silver-sulphur electrode,respectively.Enzyme-linked immunosorbent assay was used to determine the expression of methylenetetrahydrofolate reductase （MTHFR）,cystathionine β-synthase （CBS）,and cystathionine gamma-lyase （CSE）.Radioimmunoassays were used to obtain folic acid and vitamin B12 levels.Results The difference in the levels of homocysteine,folic acid,vitamin B12,hydrogen sulfide,as well as the MTHFR and CSE expression between patients with PH and without PH were statistically significant （all P ＜0.05）.Homocysteine had the best sensitivity and specificity to predict PH （P ＜0.001）.Subgroup analysis showed that the levels of homocysteine and hydrogen sulfide,and the expression of CSE and MTHFR between patients with dynamic and obstructive PH were significantly different （all P ＜0.05）.Based on the ROC curve,homocysteine had the best sensitivity and specificity to predict obstructive PH （P=0.032）,while CSE had the most significant sensitivity and specificity to predict the dynamic PH （P=0.008）.Conclusions Increased levels of homocysteine and decreased levels of hydrogen sulfide were significantly negatively correlated in PH associated with CHD.The underlying mechanism involved the decreased expression of MTHFR and CSE along with vitamin B12 deficiency.Homocysteine and hydrogen sulfide are potential biomarkers to predict PH.     

Novel biomarkers for progression of chronic kidney disease

Although there are different initiators of CKD, it is generally recognized that the secondary pathological pathway is quite common to all CKD. CKD may inevitably progress to end stage renal disease （ESRD） due to a vicious cycle of nephron destruction by progressive glomemlosclerosis and tubulointerstitial fibrosis. The chronic processes include kidney resident cell activation,     

长期他汀类药物治疗对肝功能异常冠心病患者心血管事件的预防效应及安全性评估

1 文献来源 Athyros VG, Tziomalos K, Gossios TD, et al. Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation （GREACE） study： A post-hoc analysis[J]. Lancet, 2010,376（9756）：1916-1922.     

广泛期小细胞肺癌中顺铂联合伊立替康与顺铂联合依托泊苷的比较

3背景 ·小细胞肺癌在肺癌中约占10％-15％．且大多数患者就诊时已处于广泛期,预后差。目前的标准治疗方案是依托泊苷联合顺铂或卡铂。     

儿童间变性大细胞淋巴瘤的诊断与治疗

1病历摘要 患儿,男,1岁,因“腹部皮下结节2个月余”入院。患儿于2个月前发现腹部散在丘疹样皮下小结节,无发热及疼痛,伴瘙痒,抗过敏及抗菌治疗无效。入院体查：发育营养良好,皮肤黏膜无黄染,腹部触及多个直径约0．5cm皮下结节。颌下、双侧腹股沟淋巴结多枚（0．2～0．5cm）,左侧腹股沟可触及大小约3．0×4．0cm肿物,右腋前可触及大小约5．0×6．0cm肿物,质中。余体查正常。     

Unique association of adiponectin isoforms with serum cytokines and redox molecules in patients with chronic obstructive pulmonary disease

In serum,adiponectin can exist as either full-length form that can form trimers,hexamers and high molecular weight (HMW) multimers,or as globular adiponectin (gAd).Adiponectin-deficiency leads to an increase in proinflammatory mediators and an emphysemalike phenotype,1 also protects against tobacco-induced inflammation and the increased emphysema.2 The mechanism underlying this apparent paradox remains unclear.We therefore analyzed serum levels of adiponectin isoforms,thioredoxin (Trx)/thioredoxin reductase (TrxR) activity,tumor necrosis factor (TNF)-α,IL-6and 4-hydroxynonenal (4-HNE) in patients with chronic obstructive pulmonary disease (COPD) and in control individuals.     

Interleukin-32, not reduced by salmeterol/fluticasone propionate in smokers with chronic obstructive pulmonary disease

Background The interleukin （IL）-32/tumor necrosis factor （TNF） a pathway is supposed to play a key role in the amplification of the immune response in chronic obstructive pulmonary disease （COPD） inflammation. Inhaled corticosteroids （ICS） in combination with long-acting I]2-agonists （LABA） have shown airway anti-inflammatory effects in recent studies, but the mechanism is still uncertain. Methods Patients were treated in a randomized, open-labeled, parallel group clinical trial with either a combination of salmeterol xinafoate/fluticasone propionate （SF; Seretide, GlaxoSmithKline） Diskus （50/500 pg twice daily） or ipratropium bromide/salbutamol （IS; Combivent, Boehringer Ingelheim） MDI （42 IJg/240 IJg quartic daily） for 12 weeks. At the start and the end of treatment, induced sputum was collected and the concentration of IL-32 and TNF-a, the number of neutrophUs and eosinophils were measured. Results Following 12 weeks of treatment, a statistically significant fall from baseline in the concentration of TNF-a in sputum （P=0.004） was seen after treatment with SF but not with IS. However, neither treatment had significant effects on the concentration of IL-32 in sputum. There was a decrease from baseline in the number of sputum neutrophils with SF that approached statistical significance （P=0.028） but not with IS, while the number of sputum eosinophils did not change significantly from baseline in either treatment group. There was a statistically significant decline from baseline in the quality of life as assessed by the St George＇s respiratory questionnaire in both the SF （P=0.004） and IS （P=0.030） treatment groups, but no evidence of improvement in lung function was observed in either group. Conclusion The sputum TNF-a and neutrophils, but not IL-32 and macrophages, could be reduced by ICS/LABA treatment, suggesting that IL-32 could be involved in the corticosteroid resistance of COPD inflammation.     

经纤支镜肺活检诊断肺弥漫性病变的体会

目的探讨纤维支气管镜肺活检对肺弥漫性疾病的诊断价值。方法回顾分析我院2010年-2012年收治的80例肺弥漫性病变患者的资料,均行纤维支气管镜肺活检检查,对其诊断价值和并发症进行分析。结果在本组资料中,72例患者获得病理组织学的明确诊断,8例患者因活检钳无法接触病变,检查失败,后转开胸取标本确诊,诊为肺癌36例,特发性肺纤维化15例,肺结核13例,胶原血管病12例,另4例为正常肺组织或小支气管粘膜慢性炎变。并发气胸4例,咯血3例。结论经纤维支气管镜肺活检检查能提高肺部弥漫性病变的诊断正确率,对肺弥漫性疾病的鉴别诊断和分类诊断均有重要意义,是一种安全有效的诊断方法。     

High levels of interleukin-6 and 8-iso-prostaglandin in the exhaled breath condensate and serum of patients with chronic obstructive pulmonary disease related pulmonary hypertension

Background Pulmonary hypertension （PH） is a common complication of chronic obstructive pulmonary disease （COPD）. Although alveolar hypoxia is considered as a main cause of PH in COPD, structural and functional changes of pulmonary circulation are apparent at the initial stage of COPD. We hypothesized that an inflammatory response and oxidative stress might contribute to the formation of PH in COPD. Methods We measured the levels of interleukin-6 （IL-6） and 8-iso-prostaglandin （8-iso-PSG） in exhaled breath condensate （EBC） and serum in 40 patients with COPD only or in 45 patients with COPD combined with PH. Pulmonary arterial systolic pressure （PASP） was assessed by Doppler echocardiography and defined as PH when the value of systolic pressure was greater than 40 mmHg. Results Compared with the COPD only group, the level of IL-6 in EBC was significantly increased in all 45 patients with COPD combined with PH （（8.27±2.14） ng/L vs. （4.95±1.19） ng/L, P 〈0.01）. The level of IL-6 in serum was also elevated in patients with COPD combined with PH compared with the COPD only group （（72.8±21.6） ng/L vs. （43.58±13.38） ng/L, P 〈0.01 ）. Similarly, we also observed a significant increase in the level of 8-iso-PSG in both EBC and serum in the COPD with PH group, compared with the COPD only group （EBC： （9.00±2.49） ng/L vs. （5.96±2.31） ng/L, P 〈0.01 and serum： （41.87±9.75） ng/L vs. （27.79±11.09） ng/L, P 〈0.01）. Additionally, the value of PASP in the PH group was confirmed to be positively correlated with the increase in the levels of IL-6 and 8-iso-PSG in both EBC and serum （r=0.477-0.589, P 〈0.05）. Conclusion The increase in the levels of IL-6 and 8-iso-PSG in EBC and serum correlates with the pathogenesis of PH in COPD.     

丙型病毒性肝炎与酒精性肝病的研究现状简

Alcoholic liver disease （ALD）and obesity-caused non-alcoholic liver disease are in a rising trend. ALD has become the second popular disease following the viral liver disease. A total of 90 % intaken alcohol were metabolized in the liver; long term alcohol consumption would induce liver cells to fat degenera tion, necrosis or even regeneration, and ultimately lead to ALD. Hepatitis C virus （HCV） infection is usually concealed and can gradually develop into cirrhosis and liver cancer. HCV infection plus alcoholism or ALD concurrently infected HCV can accelerate the development and progression of liver disease such as chronic hepatitis, cirrhosis and hepatocellular carcinoma. In this review, we summarize the research progress in epidemiology of alcoholic liver disease and chronic hepatitis C, the mutual influence between the two diseases, mechanisms of action, prognosis and antiviral therapy for hepatitis C infection.     

Original article：A new diagnostic algorithm for vascular cognitive impairment： the proposed criteria and evaluation of its reliability and validity

Background Vascular cognitive impairment （VCI） is considered to be the most common pattern of cognitive impairment. We aimed to devise a diagnostic algorithm for VCI, and evaluate the reliability and validity of our proposed criteria. Methods We based our new algorithm on previous literature, a Delphi consensus method, and preliminary testing. First, successive 100 patients with cerebrovascular disease （CVD） in hospital underwent a structured medical examination. Twenty-five case vignettes fulfilled the proposed criteria of diagnosis for probable or possible VCI were divided into three subtype categories： vascular cognitive impairment, no dementia （VCIND）, vascular dementia （VaD） or mixed VCI/Alzheimer＇s disease （AD）. Inter-raters reliability was assessed using a Fleiss kappa analysis. Convergent validity was also evaluated by correlation coefficients （r） between the proposed key points for each subtype and the currently accepted criteria. Forty-five patients with probable VCI were examined to determine the accuracy of identification for each subtype. Results The proposed criteria showed clinical diagnostic validity for VCI, and were able to define probable, possible and definite VCI, three VCI subtypes, and vascular causes. There was good consensus between experts （Cronbach＇s a=0.96 for both rounds）. Significant moderate to good items-total correlations were found for two questionnaires （50-r range, 0.40-0.97 and 0.41-0.99, respectively）. Significant slight and moderate inter-raters reliability were obtained for VCI （k=0.13） and three VCI subtypes （k=0.45）. Furthermore, good convergent validity was observed in a comparison of significant correlations between criteria： good （4-r range, 0.75-0.92） to perfect （3-r=1.00） validity for the VCIND subtype, and moderate to good validity for the VaD subtype （1-r=0.46; 5-r range, 0.76-0.92） and for the mixed VCI/AD subtype （r=0.92 and 1.00; 4-r range, 0.47-0.70）. Importantly, the area under receiver operating characteristic （ROC） curves for the subtypes of VCIND, VaD and mixed VCI/AD were 0.85, 0.67 and 0.93, respectively. Conclusion Our results suggest that the new VCI diagnostic algorithm might be a suitable clinical approach for assessing stroke patients.     

Determinants of health-related quality of life worsening in patients with chronic obstructive pulmonary disease at one year

Background Chronic obstructive pulmonary disease （COPD） is a major cause of morbidity and mortality worldwide and has been the leading cause of death in China.Patients with COPD have significant decrements in their health-related quality of life （HRQL）.It is necessary to identify the factors involved in worsening HRQL in order to improve the HRQL of COPD patients.However,evidence from longitudinal studies is limited.The aim of the study was to evaluate the determinants of the deterioration of HRQL in patients with COPD.Methods At baseline,a total of 491 patients with stable COPD received comprehensive assessments,including psychosocial and clinical variables,six minutes walk distance （6MWD）,dyspnea grade measured by the 5-grade Medical Research Council （MRC） dyspnea scale,anxiety and depression measured by the hospital anxiety and depression scale and HRQL measured by St.George＇s Respiratory Questionnaire （SGRQ）.Patients were then monitored monthly for 12 months to document COPD exacerbations.At the end of the study period,the SGRQ values were reassessed.A 1-year change in SGRQ total score ≥4 was defined as a deterioration of the HRQL and as the outcome.A total of 450 patients completed the 12-month follow-up and were analyzed in the present study.Results The age （mean±SD） was （65.0±10.6） years and 68.7％ of subjects were men.The deterioration of the HRQL was 26.4％.In multivariate Logistic regression,independent and graded associations were found between the baseline MRC dyspnoea grade and the deterioration of HRQL （P=0.012）,OR 3.03 （95％ CI 1.11-8.24） for patients with MRC dyspnoea grade ≥4 versus patients with MRC dyspnoea grade =1.Similarly,the number of exacerbations during the follow-up was independently and gradually increased with the deterioration of HRQL （P ＜0.001）,OR 3.03 （95％ CI 1.9-5.6） for the participants with exacerbations ≥3 versus participants with no exacerbation.The 6MWD evaluated by quartiles was negatively associated with the deterioration of HRQL with borderline statistical significance.Conclusion MRC dyspnea grade and the number of exacerbations impair the HRQL of patients with COPD.