Volume 89  ·   Issue 32  ·  2009

The development of genomics and proteomics has greatly promoted the progress of biomedicine. In recent years, the study of protein-centered functional phenotype with upper and lower gene linkage has opened up a new field for the prevention and treatment of clinical diseases. endoplasmic reticulum stress (ERS) is such a new concept. Protein function depends on its correct folding and modification, which is mainly accomplished by the endoplasmic reticulum, which also regulates the basic life activities of cells such as lipid and cholesterol synthesis, calcium homeostasis, apoptosis and autophagy. The endoplasmic reticulum determines the outcome of stressed cells by initiating and integrating subcellular organelle responses such as nucleus, mitochondria and Golgi apparatus: restoring self-homeostasis and repairing damage, or aggravating damage or even dying.

In recent years, the application of drug-eluting stent (DES) has significantly reduced the rate of restenosis after percutaneous coronary intervention (PCI). However, the factors affecting the short-term and long-term prognosis of patients after intervention are not only the lesion characteristics of coronary artery itself, the technical strategy adopted and the type of stent, but also the accompanying clinical situation and the risk factors related to arteriosclerosis have a significant relationship with the progression of restenosis and arteriosclerosis after stenting. Therefore, with the widespread application of DES, interventionists in coronary artery disease should not only pay attention to the lesions but also pay more attention to patients when making treatment decisions and evaluating prognosis.

Objective To assess the different effects of inflammation and lipid levels before and after PCI on in-stent restenosis and lesion progression. Methods Patients were studied who successfully underwent PCI with stent implantation and were received coronary angiography again after three months to one year. In-stent restenosis was observed in 94 patients and lesion progression in 65 patients. No restenosis and lesion progression occurred in 307 cases. Total cholesterol (TC), total triglyceride (TG), high density lipoprotein-cholesterol ( HDL-C ), low density lipoprotein-cholesterol ( LDL-C ), C reactive protein ( CRP ) and high sensitive CRP(hsCRP) were determined before PCI and at time of re-angiography. Results The levels of CRP and hsCRP before PCI in restenosis group were higher than those with no restenosis( CRP: median = 3. 61 mg/L and 2.86 mg/L respectively, hsCRP: median = 1.56 mg/L and 0.89 mg/L respectively, P < 0.05 ). There was also difference between two groups in CRP levels at post-PCI fullow-ups ( median = 1.92 mg/L and 1.14 mg/L respectively, P < 0.05 ). The rate of restenosis in patients with heCRP >2 mg/L before PCI was higher than that in patients with hsCRP ≤2 mg/L (X2 =4.32, P<0.05) Logistic regression showed that the risk of restenesis markedly increased in patients with hsCRP > 2 mg/L (OR = 1.89,95%CI 1.031 -3.465). Ourig the follow-up angiography the levels ofTC, LDL-C and non-HDL-C were higher in lesion progression group than those in control group[TC (4. 62 ± 1.14)mmoL/L and (4.26± 1.01 ) mmol/L, LDL-C (2.51±0. 93 ) mmol/L and(2.25±0.75)mmol/L,non-HDL-C(3.52±1.12) mmol/L and (3.20 ±0. 98 ) mmoL/L, respectively, P < 0. 05 ). Conclusion Inflammation state before and after PCI are the risk factors for in-stent restenosis, while the levels of TC, LDL-C and non-HDL-C are the important risk factors for other coronary lesion progression. Secondary prevention should be long-term emphasized and strengthened after PCI.

Objective To assess whether chronic renal insufficiency and anemia are significant independent and combined predictors of poor long-term outcomes after percutaneous coronary intervention (PCI). Methods We examined the clinical and outcome data of 3770 PCI patients based on the pre-PCI values of glomerular filtration rate (GFR) and hemog/obin (Hb). Depending on their baseline GFR and Hb, the patients were classified into six groups: normal renal function with anemia or not; mild renal impairment with combined anemia or not; severe renal insufficiency with anemia or not. The clinical features and prognosis of patients were compared. Results Significant differences were found between the groups regarding female gender, age, body mass index, prior history of hypertension, diabetes mellitus, prior stroke, acute coronary syndrome, systolic blood pressure, left ventricular ejection fraction, total serum cholesterol, LDL-C and angiographic features ( P < 0.01). When evaluated as continuous variables, GFR and Hb were independent predictors of long-term mortality after adjusting for effects of each other ( GFR : HR 0. 979, 95% CI 0.960 - 0.999, P = 0.035 ; Hemoglobin : HR 0.952, 95 % CI 0.921 - 0.984, P =0.004 ). Mild renal insufficiency with anemia ( HR 4.123,95% CI 1.637 - 10.386, P = 0.003 ), severe renal insufficiency without anemia ( HR 5.287,95 % CI 1.627 - 17.183, P = 0.006) and severe renal insufficiency with anemia (HR 7.134,95% CI 2.180 -23.342,P =0.001 ) having a statistically significant decrease in survival in patients undergoing PCI . Conclusion Renal insufficiency and anemia are significant independent and combined predictors of long-term mortality in patients undergoing PCI.

Objective To evaluate the long-term therapeutic effects of atorvastatin via cytochrome P450 (CYP)3 A4 pathway or a non-CYP 3 A4 pathway statin, provastatin, combined with clopidogrel for the patients undergoing coronary stenting. Methods Between February 2006 and March 2007, a total of 1275 patients undergoing successful coronary stenting were randomly assigned to receive atorvastatin 20 mg/d (n = 638 ) or provastatin 20 mg/d (n = 637 ). All patients received standard clopidogrel therapy. The primary end point was cardiac and cerebral ischemic events at 12 months, defined as a composite of cardiac death, non-fatal myocardial infarction (MI) or stroke. The secondary end points were major adverse cardiac and cerebral events ( MACCE), stent thrombosis and TIMI hemorrhagic events at 12 months. Results The baseline clinical characteristics, angiographic and PCI result were comparable between two groups. At 12 month follow-up, no significant difference was observed in cardiac and cerebral ischemic events between two groups (4.7% vs 5.5 %, P >0.05). Also no significant difference existed in rate of cardiac death (1.9% vs 2.5%, P>0.05), non-fatal MI (0.5% vs0.3% , P>0.05), stroke (2.4% vs2.7%, P> 0.05) and TVR (7.7% vs 5.5 %, P >0.05) between two groups. The rates of MACCE (12.4% vs 11.0%, P>0.05), stent thrombosis (2.0% vs 2.5%, P>0.05) and hemorrhagic events (13.0% vs 12.2%, P >0.05) were similar between two groups. Conclusion The 12 month clinical outcomes were similar between patients receiving atorvastatin 20 mg/d or provastatin 20 mg/d combined with clopidogrel after coronary stenting. It confirmed the efficacy and safety of the combination of clopidogrel with statins via different metabolic pathways.

Objective To assess the clinical value of multi-slice spiral CT portal venography in prediction of esophagogastric variceal bleeding. Methods The relation was detected between esophagogastric variceal bleeding and the location of left gastric vein orifice on portal system. Also the correlation was studied between the severity of esophageal varices endoscopically and the diameter of portal vein with multi-slice spiral CT portal venography. Sixty-nine patients with esophagogastric varices confirmed by both endoscopy and 16-detector row CT portal venography due to cirrhosis were enrolled. Results Excellent image quality of portal collateral vessels with CTPV was obtained in all patients. The portal and left gastric veins were visualized both with CTPV 69/69( 100% ). Esophageal and gastric varices were visualized with CTPV 62/69 (89.9% )and 50/69 (72.5% )respectively. The left gastric vein orifice was located on the portal vein in 42 cases. There was correlation between esophagogastric variceal hemorrhage and the location of left gastric vein orifice (X2 = 4. 406, P < 0. 05 ). But no relation was found between the severity of esophageal varices and the diameter of portal vein ( P > 0. 05 ). Conclusion CTPV can not only provide important and accurate information of collateral circulation in patients with portal hypertension, but also measure the diameter of collateral blood vessel. There is a higher probability of esophagogastric variceal bleeding for the patients with left gastric vein orifice on portal vein. The combined approaches of CTPV and endoscopy can not only diagnose the severity of esophagogastric varices, but also predict the risk of esophagogastric variceal bleeding.

Objective To investigate the Relationship between CAVI (Cardio-Ankle vascular Index) and the degree of coronary artery stenosis in elderly patients with type 2 diabetes, the predictive value of CAVI were evaluated using the degree of coronary artery stenosis. Methods Relevant clinical data including CAMI, BMI, blood pressure, smoking,age, Sbp, Dbp, history and blood biochemistry test were collected in 60 years or older patients with coronary artery stenosis diagnosed by coronary angiography ,and The 298 cases were divided into two groups, A group( CAVI≥9), B group (CAVI < 9), to investigate the correlativity among the level of CAVI and cardiovascular risk factors; at the same time All cases were assigned to group C (diabetes group) and group D( non-diabetic group), to Analyse the change of CAVI in coronary artery stenosis patients complicated with diabetes mellitus. Results A total of 298 eligible patients with coronary artery stenosis were enrolled. , including 163 non diabetics and 135 type 2 diabetics. The analysis result shows that there was a positive correlation among CAVI, Old age, BMI, LDL-C, multi-vessel lesion,diabetes. Conclusion The increase of CAVI was most highly related to the coronary artery stenosis. The level of CAVI might be a helpful predictive indexes to the severity of coronary atherosclerosis.

Objective To investigate the minimal invasive surgery for simultaneously treating synchronous colorectal cancer with liver metastasis. Methods From the clinical data of our department between March 2006 to June 2008, retrospectively reviewed and analyzed 5 typical cases of synchronous eolorectal cancer with liver metastasis. All were treated with 5 different strategies of minimal invasive surgery. Results All underwent laparoscopic colorectal surgery, i.e. open hepatectomy, laparoscopic-assisted hepatectomy, laparoscopic hepatectomy, laparoscopic hepatectomy plus radiofrequeney ablation and multiple therapy respectively. The mean operative time was 177 minutes, the mean blood loss 126 ml, the time of gastrointestinal function recovery 48 - 72 hours and the mean hospital stay 7 days. In the follow-up of 10 -27 months for all 5 patients, one suffered hepatic recurrence and one died. Conclusion Simultaneous minimal invasive surgery is an optional and ideal method for treating synchronous eolorectal cancer with liver metastasis.

Objective To compare the accuracy of computed tomography coronary angiography (CTCA) and adenosine stress myocardial perfusion imaging in the diagnosis of coronary artery disease (CAD) and discuss their relationship. Methods Fifty-six patients, suspected or diagnosed as CAD, were performed with CTCA, MPI and coronary angiogaphy (CAG) within 3 weeks. They were divided into 3 groups: no CAD, no obstructive CAD (coronary artery stenosis < 70% ) and obstructive CAD (coronary artery stenosis ≥70% ). Results 5 patients were diagnosed as no CAD. 19 patients were diagnosed as no obstructive CAD and 32 patients were diagnosed as obstructive CAD by CTCA. while adenosine stress MPI Suggested 26 patients normal. 18 patients had IPD and 29 patients had RPD. The sensibility, specificity, positive predictive value ( PPV ) and negative predictive value ( NPV ) of CTCA were 100%, 55. 6%, 92. 2% and 100% versus 78. 6%, 71.4%, 73. 3% and 76. 9% respectively for adenosine stress MPI. Conclusion CTCA and adenosine stress MPI provide different and complementary information on CAD, anatomical versus functional. As compared with CAG, CTCA has a high accuracy of detecting CAD.

Objective To evaluate the expressions of CD4+CD25highCD127low/- regulatory T cells (Treg) in peripheral blood from patients with transitional cell carcinoma(TCC) in urinary system. Methods The proportion of Treg population in CD4+ T cells from 93 patients with transitional cell carcinoma was evaluated. And flow cytometry was employed to analyze different clinicopathologic characteristics and detect the pre- and post-operative changes in 38 patients with benign urinary diseases and 37 healthy subjects. Results The proportion of Treg population in CD4+ T cells in peripheral blood of patients with TCC significantly increased as compared with those with benign urinary diseases and healthy subjects. There was a strong correlation between the proportion of Treg and tumor recurrence, quantity, lymph node metastasis ( P <0. 01 ) as well as pathological stage; no correlation was found between the proportion of Treg and clinical TNM stage (P > 0. 05 ). The proportion of Treg was also different at pre- and post-operation ( P < 0. 05 ). Conclusion CD4+CD25highCD127low/-regulatory T cells in peripheral blood from patients with TCC significantly increased as compared with that in patients with benign urinary diseases and in healthy subjects, it may be responsible for immune suppression in TCC patients. Tumor resection could decrease the proportion of Treg in peripheral blood, but the long-term change in immune function requires further investigations.

Objective To observe the serial changes of plasma microparticle procoagulant activity in patients with traumatic brain injury (TBI) and evaluate its correlations with outcome and pathophysiology of TBL Methods A total of 139 consecutive patients with isolated moderate or severe head trauma and 40 age-and sex-matched healthy controls were enrolled. Plasma samples were obtained on entry in healthy controls, as well as on admission and at day 1, day 2, day 3, day 5, and day 7 after TBI in the patients. Its concentration was measured by a prothrombinase assay. Results Fifty patients (36. 0% ) died from TBI in a month. After TBI, plasma microparticle procoagulant activity in the patients increased during the 6-hour period immediately, peaked in 24 hours and decreased gradually thereafter. It was substantially higher than that of healthy controls during the 7-day period using analysis of covariate ( P < 0.01 ). A multivariate analysis selected plasma microparticle procoagulant activity ( OR 1.432, 95% CI 1.194-1.719,P <0. 01 ) as an independent predictor for 1-month mortality. Plasma microparticle procoagulant activities of non-survivals were statistically significantly higher than those of survivals ( P = 0. 01 ), and plasma microparticle procoagulant activities of patients with severe TBI were obviously higher than those of patients with moderate TBI (P =0. 002) using repeated-measures analysis. Plasma microparticle procoagulant activities of patients were negatively associated with Glasgow coma scale scores using Spearman correlation coefficient (P < 0. 05). A multivariate linear regression selected plasma D-dimer level (P = 0. 012) and plasma C-creative protein level ( P = 0. 019) related to plasma microparticle procoagulant activities. A receiver operating characteristic curve identified the cutoff levels of plasma microparticle procoagulant activities ( 12.2 U/ml) predicting l-month mortality of patients with the high sensitivity (72.0% ) and specificity values (85.4%). Areas under curve (AUC) of plasma resistin level (AUC =0. 847±0.037) was smaller than those of GCS scores ( AUC = 0. 917±0. 023 ), but this difference failed to reach statistical significance ( P = 0. 104 ). Conclusion Increased activity of plasma microparticle procoagulant is found after traumatic brain injury. It may contribute to inflammatory reaction and coagulation cascade and is associated with a poor clinical outcome.

Objective To analyze the clinicopathologic features and prognosis of triple negative breast cancer. Methods The clinical datas of 477 patients of primary breast cancer which were diagnosed by pathology in the 4th Hospital of Hebei Medical University from Jan. 2004 to Dec. 2004 were analyze& All of the patients were divided into two groups according to the results of immunohistochemistry: one was triple negative breast cancer ( TNBC ) which included estrogen receptor (ER) negative, progesterone receptor (PR) negative and human epidermal growth factor receptor (HER2) negative and other was non-triple negative breast cancer. We compared TNBC with the group of non-triple negative breast cancer in the clinicopathologic features. The disease-free survival (DFS) and overall survival (OS) were analyzed by Kaplan-Meier method. Results Of the 477 patients, 12. 6% (60/477)was TNBC patients in which 76. 7% of age was younger than fifty years(46/60), 28. 3% of T >5 cm( 17/60), 68. 3% of lymph nodes metastasis (41/60) ,31.7 % of grade Ⅲ (19/60) and 13. 3% of family history of breast cancer( 8/60 ), (P < 0. 05 ). Till June 2008, the median time of follow-up was 48 months (42 - 54 months), local recurrence or distant metastasis were 26. 7% (16/60) of TNBC which was higher than 15. 3% (64/417) of non-triple negative cases; DFS was 68.3% in TNBC group and 79. 6% in the non-triple negative breast cancer group. The OS was 81.7% in TNBC group and 90. 9% in the non-triple negative breast cancer group( Log-Rank =3. 917 ,P = 0. 048 ; Log-Rank = 4. 838,P = 0. 028 ). Conclusion These patients of triple negative breast carcinoma were usually young ( age < 50), with tumor growth fast, much more invasion and poorly prognosis.

Objective To investigate the distribution of HLA-DRB alleles among the asthmatic children and find the alleles with a correlation with susceptibility or resistance to childhood asthma. Methods The sequence-specific polymerase chain reaction (SSP-PCR) was used to analyze the HLA-DRB genotype in 117 asthmatic children and 120 healthy children in Beijing. Then the frequency of each type, odds ratio (OR) and the 95% confidence interval (CI) of OR were calculated. Results The frequency of DR2. (15) in the asthmatic children was 12. 0% (28/234)vs 5.4% (13/240)in the healthy children. The frequency was significantly higher than that of nonasthmatic children ( OR = 2.590, 95% CI = 1. 266 - 5.298, X2 = 6.431, P <0.05). Conversely, the frequencies of DR4, DR6(1402), DR9 and DR53 in asthmatic children [9.4% (22/234),0.9% (2/234),17. 1% (40/234),29.5% (69/234) ]were significantly lower than that of the healthy children [ 16.3% (39/240) ,5.0% (12/240) ,31.3% (75/240) ,44.2% ( 106/ 240 ) ], P = 0. 026, 0. 008,0. 000,0. 001, OR = 0. 481,0. 157,0. 312,0.190. Multi -variate logistic regression demonstrated that the 95% CI of OR for each allele was 1. 010 - 2. 245,0. 757 - 1. 116,0. 603 - 1. 054, 0. 855 -1.014, 0.971 - 1.010, respectively. Conclusion The allele HLA-DR2 (15) is correlated with the susceptibility to childhood asthma whereas it is not related with the severity of asthma.

Objective To compare the differences between clinical diagnosis and laboratory diagnosis of fungal sinusitis. Methods One hundred cases of fungal sinusitis were reviewed in this study. The clinical characters including symptoms, physical signs, images and intraoperative signs were the main aspects of clinical diagnosis. The results of clinical diagnosis, pathology, direct observation of the nasal and sinus samples with microscope and the fungal culture were compared. Results The numbers of fungal ball, allergic fungal sinusitis, acute fulminant inrasive fungal sinusitis, and chronic invasive fungal sinusitis were 82, 10, 6, and 2 respectively. The positive rates of clinical diagnosis, pathology, direct observation with microscope and the fungal culture were 95%, 61%, 78%, and 74% respectively. There was significant difference among the positive rates of above methods (P <0.01 ). Conclusion Clinical diagnosis can be used as the preliminary method for fungal sinusitis diagnosis. The demonstrative diagnosis needs to combine all above methods. The culture was the main method for confirm the types of pathogenic fungus.

Objective To investigate the growth of prostate cancer in vitro or in vivo by inhibiting the expression of EGFR and its intracellular effective proteins with small RNA interference (SiRNA). Methods The hormone independence prostate cancer (HIPC) cell line PC-3 was transfected by EGFR SiRNA synthesized and cloned into a recombinant lentivirus vector. The growth rate of transfected PC-3 cell was measured by MTr. The expression of EGFR and the expression and phosphorylation of its intracellular proteins, such as Akt and MAPK, were detected by fluorescent Real-Time PCR and Western blot respectively. Meanwhile nude mice were transplanted with PC-3 cell to establish the tumor model and the tumor growth was observed. Results The transfection efficiency was stable over 75% in PC-3 cell transfected with the recombinant lentivirus vector carrying EGFR SiRNA and the survival rate of PC-3 cell was only 40% -50%. Such depressant effects might be obtained by inhibiting the expression of EGFR mRNA and protein to only 10% as compared with their untreated levels ( P < 0. 01 ) ; meanwhile, the expression level and phosphorylation of Akt and MAPK also obviously decreased to 76. 49% and 47. 15% respectively (P < 0.05). Compared with the control group, the proliferation activity of tumors in nude mice was inhibited significantly by 34. 83% (P < 0.05). Conclusion Lentivirus-mediated EGFR SiRNA can inhibit the growth of HIPC in vivo and in vitro by effectively suppressing the expression of EGFR and its intracellular proteins. The latter may be a potential candidate for future targeted therapy.

Objective To construct a short hairpin RNA (shRNA) adenovirus vector targeting Akt1 (protein kinase BI, PKBI/Akt1 ) and cyclooxygenase-2 (COX-2) and study its effects on the growth of SGC-7901 human gastric adenocarcinoma cell. Methods Adenovirus pGSadeno-Aktl + COX-2 (rAdS-A + C) vector was constructed and transfected into SGC-7901 cell. The proliferative activity of tumor cell was evaluated by MTT assay and flow cytometry in vitro, rAd5-HK and rAd5-A + C were injected into the established subcutancous SGC-7901 gastric adenocarcinoma in nude mice. During the observation period of 21 days, tumor volume was measured every 3 days to further observe the anti-tumor effects of rAd5-A + C on SGC-7901 cell and cell situ apoptosis was detected by TUNEL assay. Results After transfection of constructed adenovirus vector rAdS-A + C into SGC-7901 cell, cell proliferative activity in rAdS-A + C treatment group was significantly suppressed, and cell cycle indicated that control group SGC-7901 and no-load group rAd5-A + C cells in G0/G1 ,S and G2/M phases accounted for the total number of cells 49. 8%, 35.2%, 15.0% and 50. 8%, 36. 5%, 12. 7% respectively. While the treatment group rAdS-A +C in G0/ G1 ,S and G2/M phases accounted for the total number of cells 68. 1%, 21.8% and 10. 1% respectively. The tumor volume in treatment group was lower than that of control and no-load groups and the difference had statistical significance (F= 3.679, P =0. 043 ) and rAdS-A + C could induce the apoptosis of tumor cell. Conclusion Adenovirus-mediated Aktl and COX-2 shRNA can inhibit the growth of SGC-7901 human gastric adenocarcinoma cell. It may provide a new strategy for gastric cancer gene therapy.

Objective To construct a new fusion anti-caries DNA vaccine pGJGAC/VAX encoding antigens of both S. Mutans and S. Sobrinus so as to enhance the protective effect of DNA vaccine against S. Sobrinus infection. Methods The CAT fragment of S. Sobrinus OMZI76 gtf-I was amplified by semi-nest PCR and then inserted into the plasmid pGJA-P/VAX to construct the recombinant plasmid pGJGAC/VAX. The CHO cell was transfected and the expression of fusion protein detected using cellular immunohistochemistry and Western blot. Mice were immunized with pGJGAC/VAX and control plasmids via the intramuscular (I. M) or intranasal (I. N) routes. During the experiment, blood and saliva samples were collected at a 2-week interval for antibody assay by ELISA. Rats were orally challenged with S. Mutans Ingbritt or S. Sobrinus 6715 and then immunized I. N with pGJGAC/VAX, pGJA-P/VAX or pVAX1. The Keyes method was used to determine the caries activity. Results (1) CAT sequence was identical to the related sequence of gtf-I (OMZI76) in GenBank. The recombinant plasmid pGJGAC/VAX encoded the genes of antigens of both S. Mutans and S. Sobrinus. The expressed protein could respond to specific anti-Pac, anti-GLU and anti-CAT antibodies respectively. (2)As for antibody reactions, mice in the experiment group had significantly higher levels of anti-Pac, anti-GLU and anti-CAT IgG antibodies than those in the pVAX1 group (P <0. 01 ). The peak responses of specific anti-CAT antibodies were observed at 8 weeks (GAC/I. M) and 10 weeks (GAC/I. N ) and were approximately 62.13 μg/ml and 11.43 μg/ml respectively. The peak responses of specific anti-CAT IgA antibodies were seen at 8 weeks (GAC/I. M) and 10 weeks (GAC/I. N) and were approximately 0. 67% and 0. 80% respectively. (3)In the group infected with S. Mutans or S. Sobrinus, the pGJGAC/VAX-immunized rats showed significantly fewer E, Ds and Dm lesions than pVAXl-immunized rats (P < 0.05 ) and decreased Ds and Dm levels than pGJA-P/VAX-immunized rats (P < 0.05 ) while there was no obvious difference in E lesions between the two groups (P > 0.05). Conclusion A new fusion anti-caries DNA vaccine pGJGAC/VAX encoding antigens of both S. Mutans and S. Sobrinus is constructed successfully and expressed correctly in eukaryotic cells. It induces effective mucesal and systematic humoral responses so as to provide a better protection against S. Sobrinus.

Since Warren and Marshall first isolated and cultured Helicobacter pylori (Hp) in 1983, scientists have been dedicated to the study of this bacteria.In 1994, the International Agency for Research on Cancer of the World Health Organization listed it as a class I carcinogenic.About 40% of the world's population is infected with Hp, which can cause atrophic gastritis, intestinal metaplasia, atypical hyperplasia, and eventually gastric adenocarcinoma.However, only some of the infected patients will develop into serious clinical consequences.After infection with Hp, the severity of clinical consequences of patients is related to many factors.The reasons for the differences in clinical consequences are mainly reviewed from the aspects of virulence factors of Hp.

Acute pulmonary embolism is a relatively common cardiovascular emergency in clinic, and pulmonary thromboembolism (PTE) is the most common type of pulmonary embolism. Because of the lack of specificity in clinical manifestations of acute pulmonary embolism, misdiagnosis and misdiagnosis are prone to endanger patients' lives. If it can be treated in time, the prognosis will be good, so early diagnosis is very important. In recent years, many persuasive research results have been published one after another, which provides more evidence-based medical evidence for the diagnosis and treatment of acute pulmonary embolism. It is under this background that the European Society of Cardiology (ESC) published a new edition of the guidelines for the diagnosis and treatment of acute pulmonary embolism in the European Heart Journal in 2008. Compared with the guidelines of ESC 2000, the new guidelines have been updated in terms of disease risk stratification, diagnosis and treatment. This article only explains the main points of the new guidelines.

Delayed gadolinium-enhanced (LGE) cardiac magnetic resonance (CMR) was used to detect local scars caused by radiofrequency (RF) ablation procedure.The scar degree of left atrium and pulmonary vein (PV) was related to the success of ablation.Peters and colleagues of Beth Israel Deaconess Medical Center used CMR to evaluate the relationship between RF and the cardiac damage of patients with atrial fibrillation (AF) and the ablation mode and the success of treatment. The results were published in JACC Cardiovasc Imaging, 2009, 2:308-316.

The incidence of pancreatic cancer is increasingly high, and the prevention and treatment of pancreatic cancer is increasingly paid attention to. At present, the existing epidemiological evidence suggests that body mass index (BMI) is closely related to pancreatic cancer, and overweight (BMI 25~29.9) and obesity (BMI ≥30) are the high risk factors of pancreatic cancer (RR value 1.2~3.0). However, there is no further study to reveal the relationship between overweight or obesity age and pancreatic cancer.

In 2007, physicians reported a disease characterized by skin rash, conjunctivitis and joint pain in Yap Island, Micronesia. Although IgM antibodies against dengue virus were found in the plasma of some patients, it was clinically different from previous dengue fever. Subsequent experiments using reverse transcription polymerase chain reaction (RT-PCR) found Zika virus RNA in the plasma of patients instead of RNA from dengue or other viruses.

Case 1: A 23-year-old male with cyanosis for more than 20 years, aggravated year by year, palpitations, chest tightness, shortness of breath and cyanosis after activity.