Cardiorenal syndrome: pathophysiological mechanism, preclinical models, novel contributors and potential therapies

Objective To review the current knowledge about the pathophysiological mechanisms,preclinical models,novel contributors and potential therapies of cardiorenal syndrome.Data sources The literature concerning cardioranal syndrome in this review was collected from PubMed published in English up to January 2014.Study selection Original articles and critical reviews related to cardiorenal syndrome were selected and carefully analyzed.Results Cardiorenal syndrome is a condition characterized by kidney and heart failure where failure of one organ worsens the function of the other thus further accelerating the progressive failure of both organs.The pathophysiology of cardiorenal syndrome is not fully understood,but may be caused by a complex combination of neurohormonal system activation,endothelial dysfunction,proteinuria,oxidative stress,uremic toxins and other factors.Managing cardiorenal syndrome is still a major therapeutic challenge in clinical practice because many of the drugs used to control heart failure can worsen renal function,and vice versa.Non-dialyzable uremic toxins,such as indoxyl sulfate,causing detrimental effects on the heart and kidney as well as stimulation of inflammatory responses,may be an effective therapeutic target for cardiorenal syndrome.Conclusions Suitable disease models of cardiorenal syndrome are urgently needed to investigate the pathophysiology and effective therapeutic approaches to the condition.Non-dialyzable protein-bound uremic toxins that may have cardiac and renal effects may provide therapeutic benefit to cardiorenal syndrome patients.     

基于流行排序算法的病毒性肝炎证候分类

Treatment determination based on syndrome differentiation is the key of Chinese medicine. A feasible way of improving the clinical therapy effectiveness is needed to correctly differentiate the syndrome classifications based on the clinical manifestations. In this paper, a novel data mining method based on manifold ranking （MR） is proposed to explore the relation between syndromes and symptoms for viral hepatitis. Since MR could take the symptom data with expert differentiation and the symptom data without expert differentiation into the task of syndrome classification, the clinical information used for modeling the syndrome features is greatly enlarged so as to improve the precise of syndrome classification. In addition, the proposed method of syndrome classification could also avoid two disadvantages in previous methods： linear relation of the clinical data and mutually exclusive symptoms among different syndromes. And it could help exploit the latent relation between syndromes and symptoms more effectively. Better performance of syndrome classification is able to be achieved according to the experimental results and the clinical experts.     

Hallermann-Streiff syndrome: a case report

Hallermann-Streiff syndrome （HSS） is a rare syndrome primarily affecting the head and face.As a result of many life-threatening complications, such as respiratory and cardiac difficulties,2 many patients die in infancy. Here, we report a 44-year-old patient with this syndrome who underwent phacoemulsification and piggyback intraocular lenses （IOLs） implantation in both eyes to improve visual function.     

Immune reconstitution of acquired immune deficiency syndrome

Acquired immune deficiency syndrome （AIDS） is a chronic infectious disease,which the patients are infected with human immunodeficiency virus （HIV）.HIV damages the human＇s immune function and causes CD4 cell decline in the number and function.Immune reconstitution is an important treatment to AIDS.Bone marrow transplantation,adoptive immune cell therapy and cytokines infusion can all assist the immune reconstitution;highly active antiretroviral therapy （HAART） can effectively control the virus replication and benefit the immune reconstitution.HAART combined with immunotherapy is an important method of immune reconstitution in AIDS patients.Chinese medicine is playing a more and more important role in immune reconstitution.Immune reconstitution has always been effective in the whole treatment of AIDS.     

REVIEW OF RIGHT VENTRICULAR FAILURE: GENERAL CONSIDERATION

Right ventricular failure （RVF） is a complicated syndrome with multiple etiologies. RVF relates to pulmonary hypertension, left ventricle failure, and congenital heart diseases. The origin of its pathway is based on pathological gene expression and concomitant diseases. Diagnosis of RVF is a serious problem for clinicians, but none of the criteria in current clinical practice provides uncontaminated information on either systolic or diastolic function. Perioperative assessment and bedside monitoring of right ventricle function have to be revised and widely used. Right ventricle function in transplant patients demands different evaluation using biomarkers or/and autopsy. Treatment of RVF has surgical and non-surgical approaches; both are still in development and need further clarification.     

Multiple organ dysfunction syndrome due to ingestion of fish gall bladder

Objective To investigate changes in renal function, urine N- acetyl- β- D- glucosaminidase enzyme (N- AG), liver function, myocardial enzymes, the pathology of renal damage and the mechanism of acute renal failure (ARF) associated with fish gall bladder poisoning.Methods Eleven patients with acute fish gall bladder poisoning were consecutively admitted to our hospital from September 1997 to October 1999. Renal function, urine N- AG enzyme, liver function, and myocardial enzymes were assayed before and after treatment. One patient consented to a kidney biopsy and the pathology of renal damage was observed under light and electron microscopes.Results All patients had multiple organ dysfunction syndrome (MODS) and 11 patients suffered from ARF. Ten patients had liver dysfunction, ten patients had poisonous myocarditis, and 8 patients had gastrointestinal dysfunction. Renal function, urine N- AG enzyme, liver function, and myocardial enzymes were significantly improved after treatment compared with those of before treatment (P<0.05). Kidney biopsy showed that the main damage site was the proximal renal tubule. All eleven patients recovered and were discharged from the hospital.Conclusions Ingestion of fish gall bladder leads to kidney damage, as well as liver, heart and gastrointestinal tract injury. The mechanism of acute renal function failure is the serious tubular damage, confirming the location of kidney damage. Necrosis of the proximal tubules plays an important role in the development of ARF. Immediate hemodialysis is the most effective treatment.     

Sleep apnea hypopnea syndrome and liver injury

Objective A general review was made of studies involving： （1） the relationship between sleep apnea hypopnea syndrome/sleep apnea style intermittent hypoxia and liver injury and （2） the mechanism that causes the liver injury. Data sources The data used in this review were mainly from Medline and PubMed published in English from 1993 to February 2009. The search term was ＂sleep apnea hypopnea syndrome＂. Study selection （1） Clinical and laboratory evidence that sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia leads to liver injury; （2） the mechanism that causes the liver injury. Results The effect of sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia on the liver function is characterized by serum aminotransferase elevation. The liver histological injury includes hepatic steatosis, hepatocyte ballooning, Iobular inflammation, Iobular necrosis, and liver fibrosis. Sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia can cause insulin resistance and oxidative stress. Conclusions Sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia can lead to chronic liver injury, which, in most cases, is shown as nonalcoholic fatty liver disease. Insulin resistance and oxidative stress caused by sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia play an important role in the mechanism of chronic liver disease development.     

DIAGNOSIS AND TREATMENT OF THE MIRIZZI SYNDROME

Objeetves. The aim of this paper is to describe the clinical characteristics, diagnostie procedure andoperative management of Mirrizi syndrome. Methods. Sixteen cases of Mirrizi syndrome were selected and reviewed from 1987 to 1997. Results. In the 16 eases, 6 cases were male, 10 eases were female, the average age was 62. 7 years old. Ten eases were diagnosed to be Mirrizi syndrome preoperativaly(62. 5 ％ ) ; 3 cases were considered to bile duct tumor, the other 3 eases were emergency, they were confirmed the diagnosis after the operation. Conclusions. Ultrasound is recommended as the first choice of screening method, while ERCP may confirm the diagnosis. Surgical approach is considered to be the choice and technical procedures are sug-gested to prevent intraoperative injury and to repair defects of the common bile duct.     

Familial Wolff-Parkinson-White syndrome is linked to the locion chromosome 7q3

Objective Wolff-Parkinson-White syndrome (WPW) is considered to be an autosomal dominanthereditary disease, but the gene is not identified. The objective of this study was to localize the genetic loci of Wolff-Parkinson-White syndrome. Methods Linkage analysis between the disease of Wolff-Parkinson-White syndrome and 3 STR (short tandem repeats) markers on 7q3 (D7S505, D7S688, and D7S483) was tested in 3 kindreds of the Wolff-Parkinson-White syndrome (101 numbers in total) by genotyping. Results Wolff-Parkinson-White syndrome was linked to the loci above. The maximum two-point Lod score detected at D7S505 was 6. 4 at a recombination fraction (θ) of 0. 1; the Lod score of D7S688, D7S483 was 5. 3 vs 2. 5. Conclusion The gene of Wolff-Parkinson-White syndrome is located at 7q3.     

The role of connective tissue growth factor, transforming growth factor β1 and Smad signaling pathway in cornea wound healing

The cornea is a highly specialized and unique organ in the human body. Its main function is to project light from the external environment onto the retina, and it has a specific transparency to perform its function properly. The transparency and integrity of the cornea is of vital importance. The corneal wound, especially laceration deep to Bowman＇s membrane and stroma, which will inevitably cause scar formation, may cause the degeneration or even loss of sight.     

Reconstruction of extended skin defect after the radical resection procedure for penile scrotum skin cancer

Objective To investigate the reconstruction of skin defect after extended resection of malignant skin tumor in or adjacent to the genitals, and to investigate the recovery of the function of urinary system and sexual intercourse after the operation. Methods From February 1998 to August 2006,17 patients with carcinoma of sweat gland or Paget＇s disease in or adjacent to the genitals were given standard radical resections including groin lymph node dissections. The deformational changes of penis were corrected with the split-thickness skin grafts. Results A lagre split-thickness skin to cover the wound gave a good result. More than 95 % of the skin survived, and the shape and function were perfect. Conclusion It is a simple and easy way to repair the skin defect. And the patients have a normal shape and function of genitals. The erectile function and the ability of sexual intercourse is good. 7 refs. 3 figs.     

Nasal continuous positive airway pressure combined with surfactant and NO for treatment of respiratory distress syndrome, prevention of bronchopulmonary dysplasia, and brain protection

Respiratory distress syndrome （RDS） is the single .most important cause of mortality and morbidity in preterm infants and bronchopulmonary dysplasia （BPD） is a leading cause of neuro-muscular disablement and decreased lung function in the most preterm infants.     

Chinese medicine for menopausal syndrome: Current status, problems and strategies

The use of Chinese medicine(CM) for the management of menopausal syndrome is considered effective both at home and abroad,and more and more clinical studies are confirming its efficacy.However,many problems still exit in current studies,such as the standard of CM syndrome differentiation,the design methodology and criteria to assess the quality of clinical trials and the efficacy of interventions.In this paper,the authors present the CM research and treatment strategies for menopausal syndrome with concepts explaining the CM understanding of the mechanism of the disorder.It is concluded that CM is effective for menopausal syndrome,but improvement in both study methodology and treatment strategy is needed.In detail,it is firstly necessary to conduct clinical studies to evaluate the difference of various CM treatments for menopausal syndrome manifesting different symptoms,so as to establish a comprehensive treatment protocol of CM.Secondly, an acknowledged evaluation system needs to be founded,which embodies the characteristics of CM,and covers appropriate endpoint indices and parameters to objectively evaluate the effect and study quality of CM.Finally, an epidemiological survey with large sample size should be implemented with robust statistical design and CM expertise to collect data for establishing diagnostic criteria for menopause in different stages and with different symptoms.     

The importance of the differentiating syndromes for the efficacy assessment of Chinese medicine in the treatment of cancer

<正>Chinese Medicine Approach to Illness Is by Differentiating Types of Syndromes,and the Efficacy of Treatment Is Directly Related to the Accuracy of Syndrome Differentiation The greatest difference between Chinese medicine (CM) and Western medicine is the approach to diseases.CM diagnosis requires syndrome differentiation for all kinds of diseases.The syndrome is the major basis for understanding and treating     

A systematic analysis of the theory and practice of syndrome differentiation

Syndrome differentiation is a methodology unique to Chinese medicine.It threads the diagnosis process with clinical treatment into a holistic web of links to determine and regulate the patterns of dysfunctions in the human body.It is seen as the essence of Chinese medicine because it takes into account the theoretical principles,diagnostic methodologies and the modality of treatment holistically.In this process the progressive development and changes of syndromes are also considered by the physician.This paper is a systematic study of the methodology of syndrome differentiation in relation to its clinical applications in the treatment of diseases.To illustrate the efficacy of syndrome differentiation,the relationship between pattern identification and diseases is analysed to provide a guiding principle for integration between Chinese medicine and Western medicine. Diseases being selected include cancer,cardiovascular and metabolic syndromes.A study of renal and hepatic diseases related to lifestyle is also included to highlight the clinical efficacy of syndrome differentiation.The paper also includes an analytical summary of the theoretical advancements made in integrative differentiation methodology during the past five decades which links to the recent clinical thinking and practice.     

Enhancing the treatment of metabolic syndrome with integrative medicine

Metabolic syndrome,with the main clinical manifestations of obesity,dyslipidemia,elevated blood pressure,and elevated blood glucose levels,has become an increasingly prevalant global public health concern.@@Metabolic syndrome is a convergence of multiple risk factors related to cardiovascular disease.When the concept of metabolic syndrome was initially proposed,some researchers thought the concept was unnecessary,since there were already measures in place to describe the separate cardiovascular risk factors such as dyslipidemia,hypertension and diabetes.However,a large number of epidemiological investigations confirmed that even if blood glucose or blood pressure did not reach the cutoff point of the diseases,the superposition of multiple risk factors serves to amplify the damage of a single factor to the cardiovascular system.A meta-analysis of 87 clinical studies including 951 083 cases showed that the relative risk (RR) of metabolic syndrome for cardiovascular disease is 2.35,RR of death from cardiovascular disease is 2.40,and RR of stroke is 2.27.     

代谢组学在中药研究中的应用

In recent years, a novel analytical technology, metabolomics is widely used in the modernresearch of Chinese medicine （CM）. Metabolomics adopts a ＂top-down＂ strategy to reflect the function oforganisms from terminal symptoms of metabolic network and understand metabolic changes of a completesystem caused by interventions. As a holistic approach, metabolomics technology, including nuclear magneticresonance, gas chromatography-mass spectrometry, and liquid chromatography-mass spectrometry, favorableto express the meaning of basic theories of CM, CM syndrome and Chinese herb. Therefore, we believe thatmetabolomics technology will greatly benefit to development for the research of CM in the light of modernsciences.     

血瘀证日本研究现状及分子生物学分析

Blood stasis syndrome is one of the pathological concepts of Oriental traditional medicine. In Oriental traditional medicine, blood is thought of as not only blood but also as a living component of the body. In fact, blood stasis syndrome is related to not just circulation disorders but dermatological and gynecological and other diseases. In Japan, the concept of blood stasis syndrome is based on the past literature, for instance, Synopsis of Golden Chamber （Jin Kui Yao Lue）, etc. There are many signs of this syndrome, such as a dry mouth, fullness of the abdomen and rough skin. However, the levels of importance of these signs had been unclear. Therefore, in order to determine the levels of seriousness, a scoring system of blood stasis syndrome was made based on multivariate analysis by Dr. Terasawa （Terasawa＇s Blood Stasis Score）. Using the scoring system, we have studied blood stasis syndrome mainly related to blood circulation using modem techniques of analysis. From the results, we found that patients with blood stasis syndrome showed hemorheological abnormalities, and an improvement in these abnormalities was shown after administration of removing-blood stasis formulae. Furthermore, we have studied blood stasis syndrome from the point of view of molecular biology. We searched for the specific protein expression in blood stasis syndrome by proteomic analysis, and found no specific protein expression. However, there may be a possibility of developing a diagnostic algorithm for blood stasis by construction of a decision tree. During the past few years, as one of the molecular biological factors affecting blood stasis syndrome, we have been studying hypoxia inducible factor, which is located in the upstream of many genes. Above all, blood stasis syndrome is more than just circulatory deficit but encompasses the pathological concept of constant multilateral change in the living body.     

Plummer-Vinson syndrome associated with solid- pseudopapillary tumor of the pancreas

Plummer-Vinson syndrome （PVS）, also known as Paterson-Kelly syndrome or sideropenic dysphagia1 is characterized by dysphagia, iron deficiency anemia and esophageal webs. This syndrome is known to be associated with an increased risk of hypopharyngeal and/or cervical esophageal cancer. Three to 15 percent of the patients with PVS, mostly women between 15 and 50 years of age, have been reported to develop esophageal or pharyngeal cancer. There is a decreasing trend in the overall incidence of hypopharyngeal cancer in women, probably due to the diminished prevalence of PVS. There are few reports of gastric cancer in association with PVS.2[第一段]     

Toll like receptors and inflammatory factors in sepsis and differential expression related to age

In recent years, the incidence of systematic severe .infection in intensive care units （ICUs） has increased significantly. Sepsis is a＂ complex, multifactorial syndrome that can develop into conditions of different severity, described as severe sepsis or septic shock. The immunology of severe sepsis and septic shock is poorly defined, despite many studies investigating the pathogenesis of this syndrome. With mortality rates of up to 50%, greater understanding of the interactions between host and microbe is necessary to improve patient outcome. Given the rapid progression of sepsis and immediate recruitment of the inflammatory cytokine cascade, the early innate response of the immune system to the pathogen is likely to play a critical role.