Volume 88  ·   Issue 26  ·  2008

Can glucose-insulin-potassium chloride solution (GIK) improve the prognosis and survival rate of patients with acute myocardial infarction (AMI)? This discussion has been continued for nearly 30 years.The meta-analysis of clinical trials of GIK for AMI before the application of thrombolytic drugs in patients with AMI showed encouraging results. The in-hospital mortality rate was reduced by 28% in the treatment group compared with the control group, and more than 48% in the high-dose GIK group [1].

The history of cardiac rehabilitation treatment has been carried out for more than 50 years.The original meaning of the word "rehabilitation" refers to the patient's original physical and mental state facing "recovery" (social return) after treatment. I. Historical review of cardiac rehabilitation In the 1950s, the admission time of acute myocardial infarction patients took 6~8 weeks, and the treatment principle was to prohibit movement and adopt absolute bed rest. The reason was that the patient could cause heart rupture, cardiac insufficiency and even sudden death after movement.

In recent years, with the rapid development of clinical medicine, in order to guide and standardize clinical medical behavior, many clinical guidelines have been formulated abroad, and they have been continuously modified and updated. By the beginning of 2008, the largest clinical guidelines website abroad (www.guideline.gov) has published 2212 clinical guidelines, and the number of clinical guidelines in China has increased rapidly.

Objective To investigate the safety and effects of early submaximal cardiopulmonary exercise test(CPET) and cardiac rehabilitation for patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI).Methods 94 patients with AMI after PCI were randomly divided into 2 groups:exercise group undergoing anaerobic rehabilitation training based on anaerobic threshold(AT) exercise prescription for 3 months,and control group,conducting exercme according to the needs of the Datients themselves.Three months later,the exercise cardiopulmonary function was evaluated.Results In the first CPET 89 patients attained their anaerobic threshold(AT)and their heart rates were lower than their target heart rates following the exercise test.The oxygen consumption at the anaerobic threshold(VO2AT)3[(14±4)ml.min-1.kg-1,P=0.000].The LAT 3 months of the exercise group was(42±16)J.The earlv submaximal CPET and cardiac rehabilitation for patients with AMI after PCI are not only safe but also can improve their exercise capacity.

：Objective To develop asimple risk score model of in-hospital major adverse cardiac events(MACE)includingall-cause mortality,new or recurrent myocardial infarction(MI).and evaluate the efficacyabout revascularization on patients with different risk.Methods The basiccharacteristics,diagnosis,therapy,and in-hospital outcomes of 1512 ACS patients fromG10bal Registry of Acute Coronary Events(GRACE)study of China were collected to develop arisk score model by multivariable stepwise logistic regression.The goodness-of-fit testand discriminafive power of the final model were assessed respectively.The best cut-offvalue for the risk score was used to assess the impact of revascularization forST-elevation Ml(STEMI)and non-ST elevation acute coronary artery syndrome(NSTEACS)onin-hospital outcomes.Results (1)The following 6 independent risk factors accounted forabout 92.5%of the prognostic information:age≥80 years(4 points),SBP≤90mm Hg(6 points),DBP≥90 mm Hg(2points),KiHip Ⅱ(3 points),KillipⅢorⅣ(9 points),cardiac arrest duringpresentation(4 points),ST-segment elevation(3 points)or depression(5 points)or combinationof elevation and depression(4points)on electrocardiogram at presentation.(2)CHIEF riskmodel was excellent with Hosmer-Lemeshow goodness-of-fit test of 0.673 and c statistics of0.776.(3)1301 ACS patients previously enrolled in GRACE study were divided into 2 groupswith the best cut-0frvalue of 5.5 points.The impact of revascularizafion on thein-hospital MACE of the higber risk subsets was stronger than that of the lower risksubsets both in STEMI[OR(95%CI)=0.32(0.11,0.94),x2=5.39,P=0.02]andNSTEACS[OR(95%CI)=0.32(0.06,0.94),×2=4.17,P=0.04]population.However,beth STEMI(61.7%vs78.3%,P=0.000)and NSTEACS(42.0%vs 62.3%.P=0.000)patients with the risk scores more than5.5 points had lower revascularization mtes.Condusion The risk score provides excellentabillty to predict in-hospital death or (re)MI quantitatively and accurately.The patientsundergoing revascularization with risk score greater than 5.5 have lower incidence ratesof endpoint.

Objeetive To compare the long-term effects of the China-made sirolimus-ehting stent (Firebird)and the imported paclitaxel-eluting stent(Taxus).Methods From April 2004 to April 2005,314 consecutive patients underwent implantation of Firebird(rt=88,F Group),aged(57.9±10.5),or Taxus(n=226,T group),aged(57.2±10.2).Then the patients were followed up in ward or out-patients department 1.3,and 6 months after implantation and 1,2,and 3 years after implantation by phone.Seven months after implantation coronary angiogaphic follow-up was performed.Results The baseline type B2+c lesion rate of T GrouP was 85.5%,significantly higher than that of F Group(75.5%;P:0.026).The percent diameter stenosis of T Group was 70.1%±15.2%,significantly higher than that of F Group (64.4%±14.5%:P=0.026).The balloon pre-dilation rate ofT Group was 88.2%,significantly higher than that of F Group(70.9%,P=0.000).The stent length of T Group was(21.5±7.84)mm,significantly longer than that of F Group[(18.6±4.51)mm,P=0.035].The major adverse cardiac event(MACE)rate of T Group was 21.7%,significantly higher than that of F Group(8.O%,P=0.005).the target vessel revascularization rate of T Group was 16.4%,significantly higher than that of F Group(6.8%,P=0.028),however,there were not significant differences in the rates of cardiac death and fatal myocardial infarction between these two groups(0%vs 1.8%,P=0.580 and 1.1%vs 3.5%,P=0.453 respectively).There was no significant differenees in the total,early,late,and very late stent thrombosis between these 2 groups(1.1%vs 3.5%,P=0.453,1.1%vs 0.9%,JP=0.580,and:0%vs 1.3%.P=0.562,and O%vs 1.3%;P=0.562).Angiography indicated that the in-stent and in-segment restenosis rates of T Group were both significantly lower than those of F Group(0%vs 21.0%;P=0.002,and 0%vs 24.O%;P=0.001).The in-stent and in-segment late loss levels of T Group were significantly smaller than those of F Group[(0.11±O.07)mm vs(0.53±O.38)mm;P=O.000,and(0.05±0.03)mm v8(0.38 4-0.19)mm;P=O.000].Conclusion Firebird stent is more effective and safer than Taxus stent,especially is superior in the restenosis-reducing effect.

Objective To investigate the effect of high-dose glucose-insulin-potassium(GIK) infusion on the outcomes of ST-elevation myocardial infarction(STEMI)in China.Methods As part of the international multicentre CREATE-ECLA study,7510 patients with STEMI,aged(62±12),presenting their symptoms within 12 hours of onset who were hospitalized in 274 centers throughout China from July 2001 through July 2004 were randomized to receive GIK intravenous infusion for 24 hours plus routine treatment(3739)or control group(n=3771)receiving routine treatment alone.The patients were flowed up in the out-patient department 30 days after the randomization to assess the rotes of morality,cardiac arrest.cardiogenic shock and re-infarction.Results The median time from symptom onset to randomization was 5.8 hours.The mortality ofthe control group was 10.4%,not significantly different from that of the GIK group(11.2%,hazard ratio=1.05,95%CI:0.916-1.207,P=0.476).There rates of cardiac arrest,eardiogenic shock.and re-infarction of the GIK group were 0.8%,6.8%,and 2.0%respectively,all not significandv different from those of the control group(1.O%,6.4%,and 1.9%respectively,all P>0.05).At the Day 7 the heart failure rate of the GIK group was 19.7%,not significantly different from that of the control group(18.3%,P=0.102).The symptomatic hypotension rate of the GIK group was 3.7%,significantlv higher than that of the control group(1.2%,P<0.01).The phlebitis rate of the GIK group was 2.2%.significandv hisher than that f the control group(0.1%,P<0.01).The net increased fluid volume of the control grouP wasl3 584 ml.more than that of the GIK group(1036 ml).Conclusions Hish dose GIK infusion has neutral effect on mortality.cardiac arrest or cardiogenie shock in patients with acute STEMI in China.

Objective To explore the molecular mechanisms of Glanzmann thrmabasthenia caused by αⅡb P126H mutation.Methods Eukaryotic vector of αⅡb P126H WaS constructed by PCR sitedireeted mutagenesis and then co-transfected with eukaryotie vector PCDM8Ⅲa expressing the subunit β3into human renal epithelial cells of the line 293 & and Chinese hamster ovarian cancer cells of the line CHO after sequencing.The membrane expression of αⅡb P126H mutant was analyzed by flow cytometry and the whole expression was coatirmed by Western blotting.The αⅡb P126H mutant subcelhlar localization was determined by laser confocal scanning microscopy.Results The 293T cells cotransfected with cDNAs of mutated αⅡb and wild-type β3 failed to express αⅡb β3 on the cell surface as shown by FACS.Western blotting of the eell lysate showed no detectable mature αⅡb.Immunofluorescence studies demonstrated proαⅡb β3 complex colocalized with an endoplasmie retieulam(ER)marker,but showed minimal colocaliztion with an Golgi marker.Conclusion The P126H mutation in αⅡb prevents transport of the pro-αⅡbβ3 complex from ER to the Golgi body,thus hindering its maturation and surface expression.The impaired αⅡbβ3 transport is responsible for the thrombasthenia.

Objeetive To investigate the efficacy and toxicity of bortezomib of different doses in combination with dexamethasone for the treatment of relapsed or refractory multiple myelomaMM.Methods 23 patients with relapsed or refractory MM.10 males and 13 females,aged 6542-86,were randomized to 2 groups:low dose group receiving intravenous 1.0 mg/m2 bortezomibn=10on days 1,4,6.and 11twiceweeklycombinedwithdexamethasone20mg/d ondays1-4,with 3 weeks as a course of treatment.and20 standard dose group:receiving intravenous 1.3 mg/m2 bortezomibn=13combined with dexamethasone.The patients were foilowed up for 9.53-15months.The effect was determined using modified European Group for Blood and Marrow TransplantationEBMTcriteria.Results The complete responseCR+partial responsePRrate of the 1.0 mg/m2 bortezomib group was 70.O%,not significantly different from that of the 1.3 mg/m2 bortezomib group61.5%,P>0.05.The relief rate CR+near CR rateof the 1.0 mg/m2 bortezomib group was 20.O%not significantly different from that of the 1.3 mg/m2 bortezomib group38.5%,P>0.05.Only 1 cage of adverse event over the grade 3 of National Cancer Institute Common Terminology Criteria for Adverse Events occurred in the 1.3 mg/m2 bortezomib group.Five cases of infecti0118 fever and 2 cases of treatment-ossociated death occurred in the 1.3 mg/m2 bortezomib group.Condusion Bortezomib at the dose of 1.3 mg/m2 is more effective in treatment of relapsed or refractory MM than that at the dose of 1.3 mg/m2 and has more side effects.

Objective To explore metheds of chnical diagnosis and treatment of BK virus(BKV) infection in renal transplant recipients.Methods Urine samples were collected from 227 renal transplant recipients who had undergone renal transplantation at most 48 months to detect the decoy cells.Samples of vrine and peripheral bloed(BP)were collected to undergo real-time PCR to detect the BKV DNA.Part of the renal-recipients received graft biopsy.The recipients with BKV vimria or viremia were divided into 2geroups:intervention group and control group.The 51 patients of the intervention group had the doses of cyclosporine A(CsA)reduced(n=19),had their doses of FK506 reduced(n=22),or underwent replacement of FK506 witIl CsA(n=10).And other 29 patients in the control group did not receive any intervention.Acute rejection was intensively monitored.The amount of decoy cells,and BKV load in the urine and PB samples were measured again after 3 months.Results The positive rates of urine decoy cell,BKV viruria.and viremia in all pailents were 33.0%,33.5%,and 15.4%respectively.In the intervention group.the median hveh of decoy cells in urine,and of BKV DNA in urine and PB before intervention were 5.0/10 HP.1.50 x 104copies/ml and 0 copy/ml respectively;and the median levels of decoy cell in urine.and of BKV DNA in urine and PB were all 0 after intervention,all significanfly lower than those before intervention(all P<0.01).In the control group,the median levels of decoy ceils in urine.and of BKV DNA in urine and PB were 6.0/10 HP,0.79×104 copiesd/ml,and 0 copy/ml respectively before observation,and the median level of BKV load in urine ofter obsevation was 2.21 x 104copies/ml,significantly higher than that before observatiOn(P<0.01),however.the median levels of decoy cells in urine and of BKV DNA in PB were 5.0/10 HP and 0 copy/ml respectively.not significantly different from those before observation(both P>0.05).The differences between the levels of urine decoy cells,urine BKV DNA level and blood BKV DNA level of the intervention group were all significantlly greater than those of the control group(Z=-2.749,-5.089,-1.996;P=0.006,0.000,0.046 respectively).And during the intervention no acute rejection was observed.Four cases of BKVAN were diagnosed.Treatment of immunosuppression reduction showed effectiveness in 4 BKVAN recipients.The levels of decoy cells in urine,and BKV load in urine and in PB samples were all decreased.The graft functions were improved.Conclusion Urilie cytology is very convenient,useful and sensitive for the evaluation and followup ofrenal transplant patients,and can reflect renal histological presentation indirect]y.Also BKV DNAdetection in the urine and peripheral blood is important to screen the evidence of BK reaction in order to prevent irreversible graft damage of BKVAN.The treatment of immunosuppressant reduction and replacement of FK506 with CsA are effective in BKV infection recipients at the early stage.

Objectlve To investigate the expression of peroxisome prolifemtor-activated receptorrcoactivator-1(PGC-1)in the diabetic liver and the role thereof in the development of hyperglycemia and diabetes.Methods Sixteen Wistar rats were randomly divided into 2 groups:Group A(n=11),undergoing intraperitoneal injection of streptozocin(STZ)to establish diabetic rat models,and Group B (n=6)undergoing injection of STZ and subcutaneous injection of inBulin.Another 9 rats were used as noilna]controls(Group C).Then blood samples were collected from the abdominal aortas to examine the fasting blood glucose(FBG),serum total cholesterol(TC),triglycerides(TG),high density lipoprotein cholesterol(HDL-C),and low density lipoprotein cholesterol(LDL-C).Their livers were taken out.RTPCR and Western blotting were used to examine the PGC-1 mRNA and protein expression.Results The FBS and TC levels of Group A were both significandy higher than those of Group C(P<0.01,P<0.05).The PGC-1 protein expression level in liver of Group A was 2.47 times that of the Group C(P<0.01)and1.57 times that of Group B(P<0.05).The PGC.1 mRNA expression level in the liver of Group A was (165.6±41.6),significantly higher than that of Group B[(121.6±25.4),P<0.05]and that of Group C[(109.15±21.8),P<0.01].Conclusion The PBC-l protein and mRNA expression levels in the liver of diabetic animals ale significantly higher than those of the normal livers.and can be reversed by insulin therapy.High PGC-1 expression in the diabetic liver may be related to the hyperglycemia in type 2diabetes.

Objective To explore the mechanisms of pandrug-resistance(PDR)of Pseudomonas aerugiorLosa(PA).Methods Nineteen strains of PA were coilected from Huashan Hospital,Shanghai.Agar dilution method was used to detect the levels of minimum inhibitory concentration(MIC)of 14 antimicmbial drugs to the PA strains.Strain homology was investigated by entembacterial repetitive intergenic consensus-polymerase chain reaction(ERIC-PCR).To analyze the B-lactam resistant mechanisms,genes of extended-spectnnn B-lactamases(ESBLs),carbapenemase,and plasmid-mediated AmpC were amplified and analyzed by PCR and DNA sequencing.To analyze the aminoglyeoside resistant mechanisms.16 aminoglycoside modifying enzyme were screened by PCR.PCR and DNA sequencing were used to amplify and analyze the genes of DNA gyrase genes gyrA and gyrB,topoisomerase Ⅳ genes parc and pare.and qnr gene for the fluoroquinolone resistance mechanisms,to amplify and analyze study the oprD2 coding genes and inhibitor MC207110 were used to detect efflux pump for the carbapenem resistance mechanisms.Results Five types were identified in the 19 PDR-PA by ERIC-PCR,mainly type A(n=6)and type B(n=7).17 of the 19 PDR-PA strains produced VEB-3 type ESBL,1 strain of which also preduced OXA-10 type ESBL simultaneously.Both of the carbapenemase and plasmid-mediated AmpC were negative.All of the 19 PDR-PA strains produced aminoglycoside modifying enzyme,yielding ant(3")I and 18 strains of which produced aac(3)Ⅱ simultaneously.All 19 PDR-PA strains carried gyrA mutations,14 of which carried parC mutation simultaneously.qnr gene w85 negative.OprD2 coding gene sequencing analysis revealed that small fragment missing occurred to all oprD2 genes of the 19 strains.16strains showed emux pump mechanism.Conclusion The resistance mechanism of PDR-PA to cephalespofins,B-lactam/B-Lactamsse inhibitor,carbapenem,fluoroquinolones,and aminoglycosides are due to production of VEB-3-ESBL,aac(3)H,and ant(3")I aminoglycoside modifying enzyme,mutations of DNA gyrase gyrA and topoisomerase parC gene,OprD2 protein deficiencies,and emux pump overexpression.

Objeetive To evaluate the artifact sizes at 3.0 T compared to at 1.5 T caused by three kinds of metallic dental materials.and to evaluate the influences of difierent magnetic resonance imaging (MRI)sequences on the artifact.Methods Samples of metal-ceramic crown of three kinds of dental materials(Ni-Cr alloy,Co-Cr alloy,and gold alloy)were placed in a cylindrical plastic vessel filled with agarose gel.Acrylic resin crown was used as control.Images were performed by means of 1.5 T and 3.0T MRI apparatus with 4 different sequences commonly used in brain MRI sequences.Artifact diameter was talculated and eompared quantitatively.A 4×4×2 factorial design was aDplied to determine the effects on the MRI artifact of different metal materials.different sequences.and different magnetic field strengths.Results ANOVA of factorial design showed that the influences of material,magnetic field strength.and sequence were all significantly different(materials:F=124.796,df=3,P=0.000;magnetic field strength:F=9.367,df=1,P=0.003;sequence:F=3.020,df=3,P=0.036).Among the 3 kinds of alloys,the gold alloy produced the least artifact.Among the 4 imaging sequences,fast spin echo(FSE)produced the least artifact.The artifact sizes increased at 3.0 T compared to at 1.5T.Interactions among the 3 factors did not influence tlle artifacts signifieantly(P>0.05).Conclusion Selection of specific metal material and imaging sequence can minimize the metal artifacts in MRI.The increment of artifacts at 3.0 T is only by 10%compared to that at 1.5 T.But 3.0 T MRI system has great advantages.so it is eligible on patients with metal restoration.

objective To investigate the effects of sex hormones on bladder and mechanism thereof.Methods Sixty mature female SD rats tinderwent bilateral ovariectomy and then randomly divided into 6 groups:low dose estrogen group(OVX+E group)treated with estradiol benzoate 0.25 mg/kg injected intramuscularly qod.high dose estrogen group(OVX+E 1 mg group)treated with estradiol benzoate 1 mg/kg,progesterone(P)group,treated with P 1 mg,OVX+E+P group treated with estradiol benzoate 0.25 mg/kg+progesterone 1 mg.d androgen group(OVX+T group)treated with testosterone propionate 3 mg/kg.and untreated ovariectomized group(OVX group)receiving no medication.Another 10 rats underwent sham operation.Four weeks later the rats were killed with their bladders and urethros taken out to undergo light and electron microscopy.Results The thickness of bladder wall of the OVX group was (O.97±0.11)mm,significant thinner than that of the sham operation group[(1.10±0.1)mm,P<O.05)].The thickness levels of bladder walls of the OVX+E and OVX+T groups were(1.23±0.12)mm and(1.25±0.12 mm)respectively.both significantly thicker than that of the OVX group(both P<0.01)Wider spaces between tlle detrusor muscle fascicles and degeneration of detrusor muscle cells were seen in the bladder walls of the OVX group.and such phenomena were milder in the OVX+E and OVX+T groups,however,wider spaces between the detrosor muscle fascicles could be seen in the OVX+E+P group too.The hypertrophic effect on the detrusor muscle of the OVX+E 1 mg group was weaker than that of the OVX+E group.a lot of cytoplasmic vacuoles was seen in the 2 groups treated with E,especially the OVX+E 1 mg group.The bladder structure of the OVX+P group was similar to that of the OVX group.Conclusion Endogenous testosterone level as well as estrogen level Can significantly affect the bladder structure wlth a hypertrophic effect on bladder detrusor muscle.But higher doze of estrogen also has some unexpected effects which may destroy bladder structure.In addition,progesterone can compromise the effect of estrogen.

Objective To evaluate the impact of the recombined adeno-associated virus encoding soluble tumor necrosis factor related apoptosis inducing ligand gene(rAAV-sTRAIL)on proliferation and apoptosis of human hepatocellular carcinoma(HCC)cells,and to investigate the feasibility and efficiency of transfection of rAAV-sTRAIL into human HCC cells by ultrasound microbubble intensitler.Methods Human HCC cells of the line HepG2 were transfected with rAAV-sTRAIL or rAAV-sTRAIL combined with microbubble echocontrast agent and appropriate dose of ultrasound irradiation.RT-PCR and Western blotting were used to detect the mRNA and protein expression of sTRAIL gene.MTT method Was used to detect the proliferation inhibition rate.and the apoptosis rate of the HepG2 cells Was evaluated by flow cytometry.Results The expression levels of sTRAIL mRNA and protein were higher in the rAAV-TRAIL combined with altrasound microbubble group than in the rAAV-sTRAIL group(both P<0.05).The proliferation inhibition rate of the rAAV-TRAIL combined with ultrasound microbubble group Was significandy higher than that of the rAAV-sTRAIL group(P<0.05).The apoptotic effect of the rAAV-TRAIL combined with ultrasound microbubble group was greater than that of the rAAV-sTRAIL group(P<0.05).Condusion TRAIL has a potential role to inhibit e proliferation and induce apoptosis of human hepatocellular carcinoma cells.Ultrasound and microbubble echocontrast agent increase the transfection rate of rAAV vector into HCC cells.

Objective To evaluate the impact of endogenous inflammation caused by adenovims as a vector of gene therapy on monse model of acute lung injury(ALI).Methods black C57/B6 mice randomly divided into 4 research groups:(1)adenovirus encoded-lacZ genetreatment group(AdLacZ):n=AdLscZ reagent through intranasal administration to infect mice lungs at 48h before 100%O2 inhalation to induce ALI mouse model,which companied by mice survival rates recorded.B-gal protein activity in lung wag detected to show the level of LacZ DNA transgenic protein activity;meanwhile,the indices of lung wet/dry ratio and bronchial alveolar lavage liquid(BALF)analysis with protein concentration and cell elagsification were detected.Results The method of adenovirus-mediated gene therapy with intranagal administration restthed in IJacZ DNA transgenic protein activity to keep effective highly expression in lung.and the expression level maintained 2.fold increusing even after 72 h of O.inhalation compared to that before O2 inhalation(3.688 U/mg vs 1.589 U/mg);AdLacZ mice had more subjective to O2 inhalation compared to other groups.the 50%mice survival time of this group wag shorter compared to that of the PBS group [(86±3)h vs(94±7)h];also in AdLacZ group,the level of nucleated cell counting in BALF was statistically higher compared to other groups at 48 h of O2 inhalation,which following with 50%-level decreased within anther 24 h O2 inhalation;on the contrary,the level of lung wet/dry ratio and protein concentration in BALF didn,t show remarkably decreasing.Conclusion The endogenous inflammation caused by adenovirus as a vector in ALl gene therapy is temporary and rapidly weaken after getting a peak,however,enough attention still should be paid attention when evaluating the effect of gene therapy.

Objective To investigate the effect of chronic restraint stress(CRS)on the esophageal epithelial barrier function and discuss the role of emotional factors in the pathogenesis of gastroesophageal reflux.Methods Twenty-four male SD rats were randomly divided into 4 equal groups:CRS group submitted to partial restraint stress 2 h per day for 7 days,CBS+acid/pepsin perfusion group submitted to partial restraint stress 2 h per day for 7 days and then anesthetization and perfusion of hydrecldofic acid (pH=2)and pepsin(1 g/L)into the distal esophagus at the speed of 4 ml/h for 60 min,acid/pepsin perfusion group submitted to acid/pepsin perfusion into the esophagus,and control group.Then the rats were killed to collect the specimens of distal esophagus to undergo HE staining and light microscopy.Histological scoring was conducted.The diameter of intercellular spaces of esophageal epithelium wag assessed.Results The amounts offood intake and body weight increment of the CRS and CRS+acid/pepsin perfusion groups were significantly lower than those of the control and acid/pepsin perfusion groups(all P<0.01).The histological score of the CRS+acid/pepsin perfusion group was the highest.The diameter of intercellular spaces of esophagus of the CRS+acid/pepsin perfusion group was(0.516±0.010)μm,significantly greater than those of the CRS,acid/pepsin perfusion,and control groups[(O.457±0.031)μm,(0.441±0.021)μm,and(0.235±0.027)μm respectively,P<0.01 or P<0.05].The histological score of the CRS+acid/pepsin perfusion group was 2.33±0.33,significantly higher than those of the CRS,acid/pepsin peffusion,and control groups(1.17±O.31,1.33±0.33;and 0.33±O.21 respectively,P<0.05 or P<0.01).Conclusion CRS enlarges significantly the esophageal DIS and impairs the epithehal barrier function of the esophagus.Psychological factors induce or enhalice the reflux symptom in the GERD patients.agpeeiaUv in non-erosive reflux disease and functionai heartburn pafients.

The balance control of the body is a complex sensory function, which requires the transmission of sensory information from the visual, vestibular and proprioceptive systems, and is processed by the central center. Its main part is in the vestibular nucleus, which causes various motor responses [1]. When the transmission of sensory information (visual, proprioceptive and vestibular) decreases or conflicts (inconsistencies) occur, the ability of posture control decreases, which illustrates the importance of each sensory system in maintaining balance.

The patient was a 44-year-old male who was admitted to the hospital on December 28, 2007 due to fever and dry cough for more than 3 months. The patient had fever 3 months ago, body temperature 38-39℃ in the afternoon, night sweat at night, which could spontaneously decrease to normal in the morning, accompanied by irritating cough, a small amount of sputum, and occasionally bloodshot.

At present, vasopressin is widely used in clinical practice, usually as an adjuvant treatment of catecholamines in refractory septic shock. However, only two small-scale randomized controlled trials have evaluated the efficacy of vasopressin, and it is believed that it can increase blood pressure, reduce the dosage of catecholamines and improve renal function, but it is not enough to evaluate the mortality, organ dysfunction and safety of patients after its application.

In the past 10 years or so, it has been concluded whether antihypertensive therapy is beneficial to prevent stroke and other vascular events (such as cardiac insufficiency), but it is not concluded whether antihypertensive therapy is beneficial to people aged 80 years and above. Epidemiological investigations show that blood pressure is negatively correlated with the risk of death in people aged 80 years and above, and some fatal diseases (cancer, dementia, myocardial infarction, cardiac insufficiency) may occur with the decrease of blood pressure.

A 29-year-old female underwent caesarean section in a local hospital on September 28, 2006. On the fourth day after operation, she developed severe pain in the lower abdomen, high fever and peritoneal irritation. Ultrasound showed left peritoneal effusion, and peritoneal drainage tube was placed after puncture of urine. Intravenous pyelography (IVP) showed full renal pelvis on both sides, and contrast medium overflowed from the left lower ureter.

A 12-year-old male was admitted to hospital on February 20, 2008 due to abdominal pain, diarrhea and high fever (body temperature around 39℃) for more than 1 month. He was given azithromycin, but clindamycin was ineffective and his symptoms worsened recently. Physical examination showed that his body temperature was 39.4℃, his breathing was 15 times/min, his pulse was 96 times/min, and his blood pressure was 109/70 mm Hg (1 mm Hg =0.133 kPa).