Volume 89  ·   Issue 38  ·  2009

Gaucher disease (GD) is a rare autosomal recessive metabolic disease and the most common lysosomal storage disease (LSD). β-glucocerebrosidase (β-GC) accumulates in reticuloendothelial cells of different organs, causing cells to lose their original functions and produce a series of clinical symptoms. Clinically, it is divided into three types: type Ⅰ is non-neurological type (adult type), which often starts in childhood, and this type is the most common; Type Ⅱ is acute neurological type (infantile type), with acute onset and can lead to infantile death; Type Ⅲ is a subacute neurological type with slower onset than type Ⅱ, which can be divided into subtypes Ⅲa and Ⅲb.

Objective To investigate the clinicopathological characteristics,therapeutic principles and prognosis of multifocal gastric carcinomas.Methods The data of 22 patients with multifocal gastric carcinomas sursically treated at our hospital from January 1999 to December 2007 were reviewed retrospectively.Results The multifocal gastric carcinomas occurred frequently in the elderly men:the percentage of early stage gastric carcinoma was 28.9%.Eighteen patients received radical resection while 4 patients palliative resection.The 1,3 and 5-year survival rates were 80.9%.52.4%and 28.6%respectively.Conclusions A thorough gastric examination should be made before and during resection so as to avoid a missing diagnosis.The postoperative survival in patients with multifocal gastric carcinomas is similar to those with a solitary lesion.

Objective To observe and research clinical characteristics and curative effect and safety of renal transplantation from living elderly donors donating kidneys.Methods Retrospective study on the 19 living kidney donors who were over 55 years old and on the renal transplantation operations completed by our center for the past few years.Among the 19 donors,with an average age of 58 years old.Their mean creatinine clearance Was 81.7 ±2.2 ml/min.Among the 19 acceptors,with an average age of 34 years old.All kidney before the open circulation transplant performed routine O point puncture and histological examination.Results All donors smoothly spent their perioperative period without any surgical complications.All the donors keep their blood Cr in a normal range one week after the operation.There was no significant difference between posttransplantation one week and six month and one year in blood Cr and Ccr.Blood pressure and blood sugar didn't not have significant changes,urine protein(-).All receptors'renal functions recovered in early stages without DGF.7 receptors who had Ccr lower than 80 ml/min had their blood Cr decreased slowly.Among the 19 kidneys donated,3 donors'glomerulosclerosises were higer than 10 percent.Conclusions The kidney source shortage is the main factor that restricts the development of the renal transplantation currently,undoubtedly,the application of elderly donors will expand the kidney source and save more uremic patients.Renal transplantation is safe and feasible with the help of living elderly donors.

Objective To investigate the surgical treatment and prognosis of primary retroperitoneal malignant tumor.Methods A total of 191 patients with primary retroperitoneal malignant tumor treated from January 1996 to December 2007 at our hospital were retrospectively analyzed SPSS 13.0 was used to analyze the follow-up data.Results The clinical manifestations included abdominal mass [122(63.9%)],abdominal pajn[77(40.3%)]and abdominal distension[48(25.1%)].Liposarcoma[75(39.3%)]was more frequently encountered than other tumors.Among these patients,142 underwent complete resection,35 palliative resection and 14 exploratory operation.The median survival time of complete resection,palliative resection and exploratory operation were 56,33 and 11 months respectively.The difference was of statistical significance.Conclusions Surgical resection is an effective therapeutic method for primary retroperitoneal malignant tumor.Complete resection prolongs the survival time and it is effective in control of recurrent tumors.

Objective To report the preliminary experience of 4 cases of small bowel transplantation.Methods Thirty microgram of Campath 1H was infused during the small bowel transplantation.The patients received 1 gram of Solu-Medrol followed by the Campath 1 H and another gram of Solu-Medrol before reperfusion.The infusion of tacrolimus started iust after reperfusion.The route of tacrolimus administration was transferred from vein to gut tract gradually.the tacrolimus trouth levels were aimed at 10-15μg/L within the first 3 postoperative months,5-10μg/L at 4-6 months post-operation and taped to 5 μg/L thereafter.Results Two of these 4 cases survived more than one year.The follow-ups of other 2 patients were 6 and 2 months respectively.Three episodes of IND to mild acute rejection verifted by pathology through routine ileoscopical biopsy were found at 1-3 months post-operation,anther 3 episodes of IND to mild acute reiection verified during at 4-6 months post-operation and one episode of moderate acute rejection found at 7-12 months post-operation.The patients totally recovering after a low-dose steroid or bolus steroid were given respectively.The grafted intestine achieved an excellent function.And the patients discontinued TPN at 2-3 weeks post-operation respectively and lived on a normal oral intake to maintain their nutritional status.Conclusions The partial tolerance steroid-free protocol of combining Campath 1 H induction with a low-dose monotherapy of tacrolimus Can effectively controI the graft rejection in small bowel transplantation.And the grafted intestine regains an excellent function.

Objective To examine whether there was an association between epithelial neutrophil activating peptide 78(ENA-78),interferon-inducible protein 10(IP-10),vascular endothelial growth factor (VEGF)polymorphism and Chinese patients with idiopathic pulmonary fibrosis(IPF).Methods Polymerase chain reaction(PCR)and restriction fragment length polymorphism(RFLP)were performed to analyze the gene polymorphisms of ENA-78(-156G/C),IP-10(-1596C/T)and VEGF(+405G/C)in 60 IPF patients and 60 controls with trauma or bone fracture matched in age,gender and smoking status.Results The distribution of carrying GC+CC genotype frequency(20.0%)and C allele frequency (12.7%)for ENA-78 in IPF patients was significantly higher than that in healthy controls [6.7%(P=0.032)and 3.3%(P=0.008),respectively],the relative risk of suffering from IPF of-156C allele gene carrier significantly increased(OR=4.23,95% CI:1.35-13.20).The distribution of carrying CT+TT genotype frequency(10.0%)and T allele frequency(5.8%)for IP-10 in IPF patients was significantly lower than that in healthy controls [26.7%(P=0.018)and 14.2%(P=0.031),respectively],the relative risk of suffering from IPF of-1596T allele gene carrier decreased(OR=0.38,95% CI:0.15-0.95).No association was found between VEGF(+405G/C) polymorphism and IPF.Conclusions -156C allele for ENA-78 may be a risk factor of IPF and-1596T allele for IP-10 a beneficial factor of IPF.The VEGF(+405G/C)gene polymorphism has no effect upon the predisposition to IPF.

Objective To assess the effect of short-term continuous positive airway pressure (CPAP)upon 24 h glucose control via a continuous glucose monitoring system(CGMS)in patients with obstructive sleep apnea hypopnea syndrome and type 2 diabetes(OWD).Methods Eleven cases of hospitalized OWD with age 43-70(56±10)years old,body mass index 22.3-38.3(28.5 ±5.5)kg/m2 and apnea hypopnea index(AHI)12～68(45 ±23)times/h was recruited.CGMS was applied 2 days before and 4 days during CPAP treatment The 24 h.treatment hours(6 h.0:00-6:00)and nontreatment hours(18 h)glucose level and glucose variability were analyzed.Insulin resistance was assessed with fasting plasma blood glucose(FBG),plasma insulin(FINS)and homeostatic model assesment of insulin resistance index(HOMA-IR).Results Short-term CPAP treatment corrected sleep disordered breathing,and induced significant decreases of 24 h and treatment hours blood glucose level [(7.97±1.31)vs(7.52 ±0.94)mmol/L,(7.24±1.51)vs(6.77±1.65)mmol/L,both P＜0.05).Glucose variability of 24 h and treatment hours and non-treatment hours significantly decreased after CPAP treatment (1.22±0.34 vs 0.89 ±0.28,0.43±0.24 vs 0.31 ±0.18,1.23±0.89 vs 0.49 ±0.26,all P＜0.05).Short-term treatment also induced increase of insulin sensitivity,as indicated by a significant decrease of HOMA-IR(3.65±1.93 vs 2.79 ±1.68,P＜0.05).Conclusion Short-term CPAP treatment in OWD may have an improving effect not only upon insulin resistance but also upon whole-day blood glucose and glucose variability.

Objective To investigate the prevalence of Helicobacter pylori(Hp)infection among children aged 3 to 18 years old of Wuwei city,Gansu province.Methods The study was hased upon a personal questionnaire and a determination of Hp antigen using the Hp stool antigen test(HpSA)method.A total of 938 subjects and 96 families were selected in Wuwei city.Eighty children and teenagers with a definite positive Hp Mool antigen test were examined by serum Western blotting method.Results The prevalence of Hp was 72.3%(678/938)with no age difference.Prevalence of Hp infection was correlated with type of dwelling,occupation of parents,drinking water source,kindergarten attendance,consumption of raw vegetables,a poor oral hygiene and breast feeding etc.According to the multivariate analysis,drinking water source,kindergarten attendance and consumption of raw vegetables were most strongly associated with prevalence of Hp in children and adolescents.The infection rate of parents whose children were infected with Hp was higher than that of those whose children were not infected[82.3%(121/147)vs 47.4%(18/38),X2=19.736,P＜0.05].The antibody responses of 57 samples(71.3%)from 80 children were of type ⅠHp and 23 samples(28.7%)type Ⅱ.Conclusions Hp infective rate is high in Wuwei city.The data support maternal-child and sibling-sibling transmission as the primary transmission routes of Hp.The results of serological analysis confirm that the majority of Wuwei Hp infection is of type Ⅰ.

Objective To survery the frequencies and characterstics of polymorphism of seven genes coding drug-metabolizing enzymes in a Han Chinese population.Methods Genomic DNA was extracted from peripheral blood in 1382 unrelated Han Chinese volunteers.Genotypes of CYP450,NQO1,MPO,MTHFR,NAT2,TPMT*3BC460A and TPMT*3CA719G were analyzed by PCR-RFLP.GSTM1 and GSTT1 genotypes were detected by multiple PCR and TPMT*2G238C genotypes by allele-specific PCR.Results The allele frequencies of wild-type,heterozygosity and homozygosity were 99.8%.0.2%and 0 in CYP3A4*1 B genotypes,8.4%,34.3%and 57.3%in CYP3A5*3 genotypes,28.7%,49.7%and 21.6%in NQO1C609T genotypes,75.0%,23.2%and 1.8%in MPOG463A genotypes,25.9%,44.9%and 29.2%in MTHFRC677T genotypes,67.3%,30.4%and 2.3%in MTHFRA1298C genotypes,and 96.8%3.2%and 0 in TPMT*3CA719G genotypes,respectively.The frequencies of present and null genotypes were 36.1%and63.9%in GSTM1,54.4%and 45.6%in GSTT1 respectively.The frequencies of NAT2*4/*4,*4/*5,*4/*6,*4/*7,*5/*5,*5/*6,*5/*7,*6/*6,*6/*7 and*7/*7 genotypes were 34.5%,4.3%,24.3%,18.2%,0.1%,1.8%,1.5%,5.0%,7.6%and 2.6%respectively.The frequencies of spocific NAT2 alleles were 57.9%,3.9%,21.8%and 16.3%for NAT2*4,*5,*6 and *7 respectively.The frequencies of genophenotypes were 81.4%and 18.6%in NAT2 fast acetylator and low acetylator respectively.The allele frequencie of wild type were 100%in beth TPMT*2G238C genotypes and TPMT*3BG460A.The variant alleles of TPMT*2G238C and TPMT*3BG460A were not found in 1382 Han Chinese subjects.Conclusion Significant difierences in the distributions and frequencies in genetic polymorphisms of drug-metabolizing enzymes are identified between Han Chinese population and Caucasians,as well between Han Chinese population and Melanoderms while only some heterogeneity has been observed between Han Chinese population and other Xanthoderms in Asia.

Objective To compare the prevalence of sub-health status between Han people and Tibetan people.Methods Subjects were selected with two-stage clustering sampling method in Sichuan Prvince.The sub-health rating scale developed by Chen Qing-shan.et al.was employed to assess the subhealth status of subjects.The prevalence of sub-health status wag compared between two groups with logistic regression model and binomial regression model after adjusting some confounding factors,such as age,gender,marital status,hypertension,occupation,exercise,overweight,smoking and drinking status.Results Prevalence rates of sub-health status were 52.3%(3611/6911)and 57.9%(1034/1787)in Han and Tibetan people respectively.Logistic regression analyses results showed that the risk of sub-health in Tibetan people was 1.2840 times that in Han people(95%CI 1.1460～1.4390).Negative binomial model indicated that the number of sub-health symptoms was greater in Tibetan people and the risk Was 1.2908(95%CI 1.1820～1.4096).Prevalence rates of all sub-health dimensions were higher in Tibetan people.Conclusions Tibetan people dwelling in high-altitude areas are more susceptible to suffer from sub-health status.The medical researchers should pay more attention to this problem.

Objective To investigate the prevalence of hyperuricemia and its associated risk factors in treated and untreated hypertensive patients in Chinese rural area.Methods This cross-section study was performed in 5235 hypertensive patients aged 40-75 years old at Xinyang,Henan by using a multistage cluster sampling methed.All patients underwent an investigation composed of a standardized questionnaire,physical and biochemical examination.Hyperuricemia was deftned as serum uric acid levels≥420μmol/L in men or ≥360 μmol/L in women.Results The overall prevalence of hyperuricemia was 14.1%,and it was higher in men than in women(21.5%vs 10.2%.P＜0.01).With an increase of body mass index (BMI),the prevalence of hyperuricemia and serum uric acid level increased significantly in both sexes [BMI＜25,≥30:14.4%,30.4%,(328 ±83)μmol/L,(383 ±86)μmol/L in males;and 7.2%,17.0%,(251±70)μmol/L,(293 ±75)μmol/L in females,respectively,all P＜0.01].So did that with increase of age only in female patients(40-49 years vs≥70 years:5.8%-18.0%,respectively,P＜0.01).Antihypertensive treatment,lipid disorder,smoking and alcohol consumption also significantly increased the incidence of hyperuricemia and the serum uric acid level(all P＜0.01).However,no significant differences were found among patients with Ⅰ,Ⅱ,andⅢblood pressure levels(all P＞0.05).After adjustment for age and other conventional risk factors by using multiple logistic regression analysis,hyperuricemia was significantly associated with BMI.alcohol consumption and diuretics in males as well as BMI,lipid disorder,age,smoking,and antihypertensive treatment in females.Conclusions Hyperuricemia is relatively less common in rural hypertensive patients.The associated risk factors of hyperuricemia and elevated serum.uric acids include sex,age,BMI,antihypertensive medicines,lipid disorder,smoking and alcohol consumption.The effect of these factors is different between sexes.

Objective To investigate the effects of heparin upon inflammatory reaction and associated mechanism of endotoxin-induced acute lung injury(ALl)in rat.Methods Thirty-six male Sprague-Dawley rats were randomly divided into three equal groups namely:ALI group,heparin treatment group and normal control group.The ALI rats were induced by injecting endotoxin intravenously and sacrificed at 4 h after model establishment.The lung histology was scored by a modification of Smith technique.The albumin permeability of pulmonary microvaseular(Palb)was measured by single nuclide tracer technique.Tumor necrosis factor α(TNF-α),interleukin 6(IL-6)and von Willebrand factor (vWF)levels of serum were determined using commercial enzyme-linked immunosorbent assay kits.The expressions of lung tissue extacellular signal-regulated kinases(ERK)-1/2,P38 mitogen-activated protein kinase(MAPK)and c-jun N.terminal kinases(JNK)were determined by Western blotting.Results The Smith lung injury score in heparin treatment group and ALI group were(5.00±1.26)and(8.00 ±1.09)respectively.The values were significantly hisher than that of normal control group(0.67±0.52,both P＜0.01).However,the Smith lung injury score in heparin treatment group was significantly lower than that of ALI group(P＜0.01).The Palb,TNF-α,IL-6 and vWF of heparin treatment group were(0.28±0.04),(1.92±0.35)μg/L,(1.22 ±0.13)ng/ml and(24.9±4.0)U/L respectively.The values were significantly higher than those of normal control group[0.20±0.02,(0.51 ±0.09)μg/L,(0.23±0.05)ng/ml and(14.0 ±3.0)U/L respectively,all P＜0.01]but significantly lower than those of ALI group [(0.38±0.04),(2.77±0.37)μg/L,(1.62 ±0.13)ng/ml and(31.8 ±7.5)U/L respectively,all P＜0.01].The lung tissue levels of phospho-ERK1/2 and phospho-P38 MAPK expressions of heparin treatment group were markedly higher than those of normal control group.whereas markedly lower than those of ALI group.There was no marked difference of phospho-JNK expression in all three groups.Conclusion Heparin markedly inhibits the expressions of phospho-ERK1/2 and phospho-P38 MAPK,down-regulates the inflammatory reaction,attenuates the endothelial permeability of pulmonary vasculature and significanfly improves endotoxin-induced lung injury in rats.

Objective To investigate the effect of benazepril on atrial cytoskeleton remodeling in atrial fibrillation(AF)canines induced by chronic rapid atrial pacing(RAP).Methods Twenty canines were randomly divided into 3 groups:(1)Sham-operated group without RAP;(2)AF group:AF established by RAP at 600 beats per minute for 6 weeks;(3)Benazepril group:benazepril was dosed from 1 week pre-pacing to 6 weeks post-pacing.The diameter of atrial cardiomyocyte was measured,collagen volume fraction(CVF)analyzed by Masson staining and the expression and distribution of desmin were assayed by immunohistochemistry.RT-PCR method was used to semi-quantify the mRNA expression of β-tubulin and desmin.Results The diameter of atrial eardiomyocyte increasod in AF group [LA:(27.9±3.8)μm;RA:(26.8±3.2)μm]and benazepril group[LA:(25.1 ±3.4)μm;RA:(25.2±3.5)μm]than sham-operated group[LA:(19.6±2.9)μm;RA:(18.7 ±2.6)μm](P＜0.01).CVF increased in AF group than sham-operated group[LA:(16.9±1.1)%vs(9.2 ±0.9)%,RA:(15.7±2.3)%vs(9.3±0.8)%,P＜0.01]and it decreased in benazepril group than AF group[LA:(11.3±0.8)%vs(16.9 ±1.1)%,RA:(10.9±0.8)%vs(15.7±2.3)%,P＜0.01].Normal desmin cross-striations were lost in atrial cardiomyocyte and the desmin organization became irregular in AF group.The A values analyzed by immunohistochemistry of desmin increased in AF group than sham-operated group and they decreased in benazepril group than AF group(P＜0.01).The expression of mRNA level of desmin and β-tubulin were up-regulated in AF group than sham-operated group,(LA:1.0 ±0.3 vs 0.6 ±0.3,0.9 ±0.4 vs 0.6 ±0.3;RA:1.0±0.6 vs 0.6±0.2,1.1 ±0.3 vs 0.7 ±0.4,P＜0.01)and they were down-regulated in benazepril group than AF group(LA:0.8 ±0.4 vs 1.0±0.3,0.7±0.3 vs 0.9±0.4;RA:0.7±0.3 vs1.0±0.6,0.7±0.3 vs 1.1±0.3,P＜0.01).Conclusion Benazepril Can favorably improve atrial cytoskeleton remodeling in the canine atrial fibrillation model.

Objective To investigate the molecular identities of L-type calcium channel α1C subunit(Cav1.2)and α1D subunit(Cav1.3)responsible for motor dysfunction of diarrhea-predominant imtable bowel syndrome(D-IBS).Methods A total of 30 male Wistar rats were randomly divided into two groups.The traditional method for irritable bowel syndrome in a cold environment and intragagtric administration of Folium Cassiae were combined to develop the D-IBS model.The fecaJ particles of rats and the water content in feces were meagured.Then the expression of Cav1.2 and Cav1.3 mRNA wag detected by reverse transcription polymerasc chain reaction.The expressions of Cav1.2 and Car1.3 were examined by immunohistochemistry in colonic tissues from D-IBS model rats and matched tissues.Results The fecal particles and the water content in feces of D-IBS model rats significantly increaged as compared with the normal rats(6.8±1.4 vs 3.2 ±0.8.P=0.032.80%±4%vs 47%±5%,P=0.018).Cav1.2 and Car1.3 were positively expressed in colon of both model group and control group rats.The immunohistochemical scores of Cav1.2 and Car1.3 expression inereaged in colon of D-IBS model rats as compared with those in normal control rats(3.43 ±0.92 vs 2.82 ±0.60,P=0.034,4.32 ±0.51 vs 3.75 ±1.05.P=0.039).The immunohistochemical scores of Cav1.3 expression were significantly higher than Cav1.2 in colon of both two group rats(P=0.003,0.005).Similarly,the expression of Cav1.2 and Cav1.3 mRNA increased in colon of D-IBS model rats as compared with those in normal control rats(1.18 ±0.15 vs 1.06 ±0.12,P=0.023,1.32 ±0.13 vs 1.23 ±0.13,P=0.033).The expression of Cav1.3 mRNA wag significantly higher than Cav1.2 in colon of both two group rats(P=0.038,0.012).Conclusions The traditional modeling of irritable bowel syndrome in rats alters the expression of Cav1.2 and Car1.3.It may be directly related to the generation of enhanced colonic contraction in D-IBS.In addition,Cav1.3 may play a more important role than Cav1.2 in colonic contractility.It offers another potential therapeutic target in the treatment of irritable bowel syndrome.

Objective To construct a novel 10-23 deoxyribozyme(10-23DZ)expression vector,identify the intracellular production of specific 10-23 DZ and its inhibitory effect upon the expression of TACO gene in macrophage.Methods An oligonucleotide containing the primer binding sequence of mouse Moloney leukemia viral reverse transcriptase(MLV-RT),a multiple cloning site(MCS)and a stem-loop structure for termination of reverse transcription was designed and inserted into one MCS of plasmid pBUDCE4.1,downstream of the cytomegalovirus promoter(PCMV).The gene fragment encoding MLV-RT was inserted into another MCS of pBUDCE4.1,downstream of elongation factor 1α promoter(PEF-1α).The resulting plasmid was named pSDE01.Then pSDE01 was transfected into RAW264.7 cell and the expression of MLV-RT and the reverse transeriptase activity of expression product was identified by RT-PCR.To identify the cellular expression of 10-23DZ by pSDE01.a 10-23DZ targeting the TACO mRNA of macrophage was designed according to the predicted Secondary structure of TACO mRNA.The expression sequence of designed 10.23 DZ,DZ1,was synthesized and inserted into the MCS of ODN-PSL in pSDE01.The resulting plasmid,pSDE01-DZ1,was transfected into RAW264.7 cell and the expression of DZ1 wasidentified by PCR and dot-blot respectively. At 48 h after transfection of pSDE01 into RAW264.7 cells,total RNA and proteins were extracted and the TACO mRNA and protein expression level was assayed by RTPCR and Western blotting respectively. Results Restrictive analysis and sequencing data showed that the 10-23DZ expression vector, pSDE01, was successfully constructed and could express MLV-RT with reverse transcriptase activity in cell. When transfected into RAW264. 7 cells, pSDE01-DZ1 expressed DZ1 effectively and inhibited the expression of TACO gene. And TACO mRNA decreased by 77.7% (0. 193 ±0. 008 vs 0. 864 ±0. 005, P ＜0.05) and TACO protein decreased by 73.3% (0. 114 ±0.051 vs 0.427 ±0. 043, P ＜ 0.05 ). Conclusions A novel expression vector capable of generating specific 10-23DZ in cells has been successfully constructed. And the intracellular product 10-23DZ may inhibit the expression of any target gene of interest.

Adiponectin, as a cytokine specifically secreted by adipose tissue, plays an important role in energy, glucose and lipid metabolism, anti-atherosclerosis and inflammatory response, among which adiponectin regulates islet cord sensitivity and participates in insulin resistance, which has attracted special attention of scholars [1-5]. Previous studies have found that low adiponectin level in blood is a molecular marker of insulin resistance [1], and can predict the occurrence of type 2 diabetes [6]; Injection of adiponectin into animal models or overexpression of adiponectin in vivo can increase insulin sensitivity and improve glucose metabolism [7-8].

Chinese Medical Journal, Issue 24, 2009<This article introduces the main pathogenic characteristics, epidemic characteristics and etiological diagnosis of hand, foot and mouth disease, and has a lot of benefit after reading it. In the treatment principle of hand, foot and mouth disease, the article says: "adjuvant antiviral therapeutic drugs, such as interferon and gamma globulin, can alleviate the replication and spread of hand, foot and mouth virus", and classifies gamma globulin as "adjuvant antiviral therapeutic drugs", and believes that gamma globulin "can alleviate the replication of hand, foot and mouth virus". The author thinks this statement is worthy of discussion.

Anticoagulation and thrombolysis are the main therapeutic methods for acute pulmonary thromboembolism (PTE).<The diagnosis and treatment guidelines of pulmonary thromboembolism (draft)>, but the treatment plans in the guidelines are mostly formulated with reference to foreign experience.In the thrombolytic therapy of acute PRE, the more positive indication is large-area PTE with hemodynamic changes, and for sub-large-area PTE with right ventricular function changes, the efficacy and long-term prognosis of thrombolytic therapy need to be confirmed by large sample clinical studies.

The main pathogenesis of osteoporosis is the imbalance of bone remodeling. Bone remodeling refers to the removal of local old bone and replacement of new bone, that is, osteoclast and osteoblast are a paired and coupled cell activity process. Bone remodeling is an important replacement mechanism of mature bone tissue. Nuclear factor kB ligand activating factor receptor (RANKL) plays an extremely important role in the growth, development and function of osteoclast.

Recently, Canadian scholar Juurlink and other studies have found that compared with pyrolitazone, rosiglitazone in elderly patients can significantly increase the risk of heart failure and death.

Lymphadenopathy can cause swelling and dysfunction of the affected limbs. Kathryn et al. conducted a 1-year randomized controlled trial to evaluate the effect of restrictive weight exercise on lymph node edema in patients with breast cancer after surgery. The results of the study were published in the New England Journal of Medicine (Nengi J Med, 2009, 361:664-673) published on Aug. 13, 2009.

Medium molecular hydroxyethyl starch 130/0.4 (Wanwen) is the third generation artificial colloid, and its curative effect of maintaining colloidal osmotic pressure is similar to that of plasma, and it has been widely used in the early treatment of burn shock [1]. In recent years, we have found in clinical practice that although Wanwen can help patients to pass the shock smoothly, because Wanwen does not contain protein components, it cannot timely supplement the loss of protein in burn patients during shock period, which can lead to low serum protein in patients, which is not conducive to later treatment [2]. Based on this, we have further carried out the research on the curative effect and serum protein changes of Wanwen in liquid resuscitation treatment in pre-shock of burn patients with different degrees, in order to provide a basis for the selection of clinical indications of Wanwen.

Giant cystic lymphangioma of the breast is very rare. We have misdiagnosed one case. The clinical manifestations are reported as follows. At the same time, combined with literature review, the clinical characteristics and therapeutic effect are discussed.

A 58-year-old male underwent piggyback orthotopic liver transplantation in the First Affiliated Hospital of Guangxi Medical University on November 28, 2006 due to "primary hepatocellular carcinoma and post-hepatitis B cirrhosis (decompensated liver function stage)". He recovered smoothly after the operation. Six months after the transplantation, he was readmitted to the hospital due to chills, fever and gangrene. Ultrasound, CT and endoscopic retrograde cholangiopancreatography (ERCP) showed that the common bile duct anastomosis stenosis and intrahepatic bile duct dilation were all revealed.