Volume 89  ·   Issue 42  ·  2009

For a long time, there has been a lack of consensus on the ideal level of 25 (OH) D in serum, and the criteria for judging vitamin D deficiency are also inconsistent. However, most experts agree that the level of 25 (OH) D below 50 nmol/L (20 ng/ml) is vitamin D deficiency, while the level of 52-72 nmol/, L (21-29 ng/ml) is vitamin D relative deficiency, and>75 nmol/L (30 ng/ml) is vitamin D sufficiency. According to this criterion, vitamin D deficiency is global. It is estimated that 1 billion people suffer from vitamin D deficiency or relative deficiency [1].

Primary osteoporosis is a complex disease caused by genetic and environmental factors. It is a systemic skeletal disease characterized by decreased bone mass, destruction of bone microstructure, decreased bone strength, increased bone fragility and easy fracture [1-2]. Osteoporosis suffers from postmenopausal women and elderly men. China has entered an aging society, and the harm of osteoporosis is prominent and serious. This paper briefly describes the epidemiology of osteoporosis and its fracture.

Objective To investigate the role of the cross-talk between estrogen receptors and peroxisome proliferator-activated receptor gamma in daidzein's prevention and treatment of osteoporosis in the ovariectomized rats.Methods Sixty four-month-old Sprague-Dawley(SD)female rats were divided into six groups.Four weeks after the establishment of osteoporosis model,the ovariectomized rats were adminis tered different drugs by gavage respectively for three months.After sacrificeing,the expressions of mRNA of ERα,ERβ and PPARγ in L6 and right femur were measured by realtime-RT-PCR,while proteins were detected by immunohistochemistry.Results The expressions of ERα mRNA and protein were significantly lower than that of ERβ in three dosing groups.Excepting that of rat femur of rats in H-Dai group, the expressions of ERβ mRNA of lumbar spine and femur in M-Dai group(0.0177±0.0010,0.0245±0.0013)and L-Dai groups(0.0276 ±0.0027,0.0278±0.0044)and lumbar spine in H-Dai group(0.0163 ±0.0037)were significantly higher than that in OVX group(0.0016±0.0005,0.0041±0.0014).There was no significant difference with E2 group.At the same time,the expression of ERβ protein showed into the similar trend as that of mRNA.And there was an rising expressions of ERβ while daidzein dose decreased.On the contrary,the expressions of PPARγ mRNA and protein decreased.Conclusions There is an inverse cross-talk relationship between ERβ and PPARγ,it may play a role in daidzein's prevention and treatment of osteoporosis in ovariectomized rats.

Objective To evaluate the effects of long-term bisphosphoate administration (incardronate)upon the mean degree of secondary bone mineralization. Methods Thirty aduit beagles were divided randomly into three groups of CNT, YML and YMH based upon their body weights(5 males and 5 females in each group).Animals in CNT were orally given lactose 12 mg·ks-1·d-1 while those in YML and YMH were orally given incadronate disodium at doses of 0.3 mg·kg-1·d-1 and 0.6 mg·kg-1·d-1 respectively.The dosing procedure lasted for three years.Prior to sacrifices, all animals were double-labeled excised for evaluation.Results Histomorphometry showed that activation frequency in YML and YMH [(4.93±0.92)/mm2 and(2.50±0.78)/mm2 ]were significantly lower than that in CNT(7.83±0.96)/mm2 per year.The mean degree of mineralization in bone in YML and YMH(1.40±0.12,1.48±0.09)were significantly higher than CNT(1.07±0.06).The increments were 31% and 38% respectively.Conclusion Long-term and high-dose bisphosphonate administration significantly suppresses bone turnover so as to increase the degree of bone an mineralization. But there is no resulting bone overmineralization. (incardronate)administration on the mean degree of secondary mineralization in bone.

Objectlve To study bone mass changes and its mechanisms in murine knockout apolipoprotein E(ApoE-/-).Methods Both 28-week-old male ApoE-/- mice(n=6)and wild-type (WT) mice (n=10) were euthanized.The trabecular and cortical bone micmarchitecture were assessed by micro-CT(μCT)in right distal femur.The total body BMD(bone mineral density)of left femur was determined by dual-energy X-ray absorptiometry(DXA).The serum concentrations of osteoprotegerin (OPG) and receptor activator of nuclear factor kB ligand (RANKL) were analyzed using enzyme-linked immunosorbent assay(ELISA).The left tibias were dissected and fixed in 4% paraformaldebyde after decalcifled in 0.15M EDTA bufferfor 30 days.And the expressions of OPG and RANKL were detected by immunohistochemical staining.Results Compared with WT mice, the ApoE-/-mice showed an increased volumetric BMD(294±38)mg/mm3,tissue BMD(627±23)mg/mm3,BMC(bone mineral content)(0.57 ±10.08)mg,bone volume fraction(20.38±4.74)%, trabecular number(6.67±0.78)mm-1,trabecular thickness(0.03±0.01)mm with an decreased bone surface fraction(69±18)mm-1,trabecular separation(0.12±0.01)and structure mode index(1.73±0.24).The total body BMD was higher in ApoE-/- mice than WT mice[(0.063±0.004)g/cm2 vs(0.056±0.004)g/cm2].The serum level of OPG was significantly higher in ApoE-/- mice than WT mice [(4.98±0.97)ng/ml vs (3.54±0.65)ng/ml].The results of immunohistochemical staining showed that the OPG expression was at a higher level in bone cell of ApoE-/-mice and RANKL showed no obvious change in either sera or bone cells.Conclusion A decreased bone resorption causes an increased bone mass in ApoE-/-mice and leads to an imbalanced ratio of OPG/RANKL.

Objective To investigate whether the polymorphism of osteoprotegerin(OPG)gene is associated with the change of BMD(bone mineral density)after alendronate therapy in postmenopausal women with osteoporosis and determine the correlation between genotypes and therapeutic effect.Methods Eighty postmenopausal osteoporotic patients were recruited with an average age of(64.2±7.7)years old. Every patient took oral alendronate(Fosamax)70 mg weekly and Caltrate 600 mg daily for 12 months.At pre-and post-treatment.BMD was measured at lumbar spine 2-4 and hip sites.PCR-RFLP was performed for three polymorphisms at the promoter site of OPG gene(A163G,T245G and T950C).Results One-year therapy was accomplished in 67 patients.Patients with G allele(genotype AG and GG)of site A163G,the baseline BMD of vertebral L2-4,inter-troche and total hip were lower than genotype AA[(0.732±0.113)g/cm2 vs(0.819±0.157)g/cm2,(0.775±0.101)g/cm2 vs(0.843±0.124)g/cm2 and(0.667±0.105)g/cm2 vs(0.725±0.091)g/cm2].Patients with G allele(genotype TG and GG)of site T245G,baseline BMD of vertebral L2-4, inter-troche and total hip were lower than genotype TT[(0.723±0. 111)g/cm2 vs(0.819±0.155)g/cm2,(0.776±0.102)g/cm2 vs(0.840±0.124)g/cm2 and(0.670±0.109)g/cm2 vs(0.721±0.091)g/cm2].After one-year therapy,at site A163G,the percentage of BMD change at inter-troche was higher in genotype AA than in genotypes AG and GG[2.50(3.47)% vs 0.88%(3.47%)%,P=0.014].While at site T245G,the percentage of BMD change at inter-troche and total hip were higher in genotype TT than in genotype TG and GG 2.50%(3.47%) vs 0.61%(3.31%),P=0.011;2.72%(2.68%) vs 0.89(3.01%),P=0.046].Concision The G allele of sites A163G and T245G may be the risk allele of postmenopausal osteoporosis.Furthermore, patients with genotypes AA (A163G)and(T245G)show a better therapeutic effect to alendronate.

Objective To evaluate the effect of atorvastatin on postoperative atrial fibrillation(AF) in patients undergoing coronary artery bypass gafting(CABG).Methods A cohort of 140 consecutive patients without a history of documented AF or previous statin use,who were scheduled to undergo selective CABG.were enrolled Included patients were randomly assigned to atorvastatin group(n=71) who were administered atorvastatin 20 ms/d or to control group(n=69).After CABG,subjects were monitored continuously by electrocardiographic monitors at least 7 days.During the initial postoperative 7 d,the incidence and duration of AF were recorded.And the levels of high-sensitivity C-reactive protein(hs-CRP) were meaguFed before and 24 hours,72 hours,7 days after operation,respectively.The statistical software package SPSS(version 13.0)were used to analyze the data.The differences between groups were evaluated by χ2-test for discrete variables and student t-test for continuous variables.Multivariate logistic regression analysis was performed to determine the independent predictors of early postoperative AF.Results During initial postoperative 7 d,AF occurred at least once in 10 cages in atorvastatin group,with a prevalence ofroughly 14%,and in 23 cases in control group,with a prevalence of approximately 34%(P=0.009).The mean duration of single AF was 3.6±0.4 hours in atorvastatin group and 5.7±0.5 hours in control group (P＜0.01),respectively.The multivariate logistic analysis showed that perioperative atrovastatin administration was an independently risk factor for early postoperative AF(OR=0.219,0.076-0.633,P=0.005).There was also statistical difference in hs-CRP after CABG between the two groups.Conclusions Perioperative atrovastatin administration may inhibit inflammatory reaction,reduce the incidenee and duration of postoperative AF,hence may prevent and treat postoperative AF.

Objective To investigate the antimicrobial resistance of community respiratory pathogens isolated in China.Methods The strains of Streptococcus pneumoniae,Haemophlus influenzae,Moraxella eatarrhalis,S.pyogenes were isolated from patients with community-acquired respiratory tract infections at 14 Chinese hospitals from 2005 to 2007.Etest and disk diffusion methods were used to survey the susceptibility of 14 antibiotics against these strains.These antibiotics included penicillin G,ampicillin,amoxicillin/clavulanic acid,eefaclor,cefprozil,ceftriaxone,cefepime,levofloxacin,gatifloxacin,ciprofloxacin,tetracycline,clindamycin,erythromycin and trimethoprim/sulfamethoxazole(SXT).Results A total of 1870 strains were collected including S.pneumoniae(n=997),s.pyogenes(n=176),H.influenzae(n=499)and M.catarrhalis(n=198).The 2005-2007 preyaience of penicillin-susceptible S.pneumoniae(PSSP) were 92.6%,73.9%.74.1%and penicillin-intermediate S.pneumoniae(PISP)4.5%,9.5%,14.3%and penicillin-resistant S.pneumoniae(PRSP)2.9%,16.6%,11.6% respectively.36.9%of S.pneumoniac strains isolated from≤6 years old children were penicillin-nonsusceptive isolates(PNSSP)and＜22.0%of PNSSP isolated from other age groups.The susceptible rates of β-lactamase antibiotics to PRSP and PISP isolates were less than 25.0%and 49.2%respectively.From 48.5%to 98.6%PSSP isolates were susceptible to β-lactamase antibiotics.The susceptible rotes of PNSSP and PSSP to erythromycin.tetracychne and SXT were below 7.1%and 32.1%respectively.About 95% S.pneumoniae were susceptible to ciprofloxaein.levonoxacin and gatifloxacin.All of S.pyogenes isolates weresusceptible to β-lactamase antibiotics,and 16.7%,27.1%and 15.6% of S.pyogenes isolates were susceptible to erythromycin.8.5%,19.9%,15.3%of H.influenzae and 57.4%,78.8%,95.5%of M.catarrhalis produced β-lactamase during the 3-year period.The susceptible rates of cefepime,ceftriaxone,gatifloxacin.levofloxacin and ciprofloxcin to H influenzac and M.catarrhalis were≥92.9%.Conclusions Antimicrobial resistance in S. pneumoniae is rising.The prevalence of PNSSP isolated from children≤6 years old is higher than other age groups.Amoxicillin-clavulanic acid,ceftriaxone,cefepime,gatifloxacin and levofloxacin remain highly active against common community respiratory pathogens.

Objective To investigate the effects of obstructive sleep apnea-hypopnea syndrome (OSAHS)upon cardiac structure and function of patients.Methods According to apnea hyponea index,75 OSAHS patients were divided into three groups:mild(n=25),moderate(n=25)and serious(n=25);according to the course of disease,＜5 years(n=22),5-10 years(n=26)and＞10 years(n=27).The control group included 25 healthy adults. All subjects received polysomnogram and echocardiography.The following parameters were recorded:aortic dimension,pulmonary artery inner diameter, chambers heart size,interventricular septal thickness,anterior wall thickness and movement extent of end-diastole right ventricle,left ventriculal ejection fraction(LVEF), shortening fraction(FS)and E/A ratio, etc.Results Pulmonary artery inner diameter of mild, moderate,serious and control groups were (21.4 ±2.5),(24.7 ±2.0),(26.7±2.1),(21.2±2.7)mm,right ventricle internal diameter (19.0±1.8),(22.0±2.1),(23.9±2.1),(18.9±1.8)mm,and anterior wall thickness of right ventricle(4.7±1.2),(6.5±1.3),(7.5±1.4),(4.1 ±1.0)mm The moderate and serious groups were all higher than control and mild groups obviously(P＜0.01).The serious group Was higher than the moderate group(P＜0.01).LVEF of four groups:(63.1±8.1)%,(60.0±10.2)%,(54.5±9.1)%,(63.6±7.7)%,FS:(38.1±4.3)%,(37.0±6.4)%,(33.6 ±5.4)%,(39.5±4.9)%,and E/A:(1.13±0.13),(0.96±0.16),(0.85±0.12),(1.28±0.15).LVEF and FS of the serious group were lower than those of the control,mild and moderate groups(P＜0.05).E/A ratio of the mild,moderate and serious groups were lower than the control group(P＜0.01).The interclass comparison of mild, moderate and serious groups had significant differences(P＜0.01).Right ventricle internal diameter,pulmonary artery inner diameter,anterior wall thickness of right ventricle of＞10 years group were higher than 5-10 years group obviously(P＜0.05,P＜0.01).The 5-10 years group was higher than the＜5 years and control groups obviously(P＜0.05,P＜0.01).LVEF,FS,and E/A ratio of＞10 years group were lower than 5-10 years,＜5 years and control groups obviously(P＜0.05,P＜0.01).Conclusion OSAHS causes structural and functional cardiac changes worsening with disease aggravation and course extension.

Objective To evaluate the protection of urinary function after laparoscopic radical resection with pelvic autonomic nerve preservation(PANP)for rectal cancer. Methods Prospectively 139 patients with middle or low rectal cancer receiving surgery during November 2005 to October 2007 were divided into two groups(L-PANP,n=63;O-PANP,n=76).The radicalism and safety of L-PANP surgery were analyzed and the effects upon urinary function between the two groups assessed by follow-ups and urodynamic study.Results Patients receiving subtypes Ⅰ and Ⅱ of L-PANP surgery had less decrease in contraction of bladder than those receiving the same subtype of O-PANP surgery at 10 days post-operation (Z=-2.358,P=01 018; Z=-2.268,P=0.033).And no difference was observed in patients receiving subtype Ⅲ PANP surgery(Z=-1.302,P=0.237).However,no matter which subtype of PANP surgery,Datients of L-PANP group had a better contraction of bladder than those of O-PANP group at 1 month postoperation(P＜0.05).The 1-year survival rate was 98.0%(50/51)in L-PANP group and 96.6%(57/59)in O-PANP group.And no statistical difference was found between them(P=0.898).Meanwhile,the 1-year relapse rate of pelvic cavity was 3.9%(2/52)in L-PANP group and 5.1%(3/59)in O-PANP group.And no statistical difference was found between them(P=0.867).Conclusion As compared with O-PANP surgery, L-PANP surgery shows a superiority in protection of urinary function.

Objective To screen the allergic asthma-specific allergen from complementary DNA (cDNA)expression library of humulus pollen.Methods Screened the humulus pollen λTripIEx2 cDNA expression library which had been constructed using the method of immunological screening with patients' blood serum of humulus pollen allergic asthma,extracted the positive phage DNA and the positive phage DNA.and identitied by double restriction enzyme with EcoR Ⅰ,Hind Ⅲ and agarose gel electrophoresis.Then the DNA fragments were sequenced and the repeats and sequence homology were analyzed.Results After 3 rounds of screening,three specific allergic cDNA clone of humulus pollen were obtained and the sequences were 868,550 and 592 base pairs respectively.The results of sequencing showed that these three clones represented different cDNA sequences.The repeats analysis found no repeats and these clones had no high homology with any known gene.Conclusions Three specific allergic cDNA clones of humulus pollen obtained may be new genes.It provides a rational basis for constructing a recombinant allergen or nuclear acid vaccine.

Objective To investigate the mechanism of ursodeoxycholic acid(UDCA)in hepatocyte apoptosis using differentiated hepatocytes derived from bone marrow mesenchymal cells.Methods Rat bone marrow mesenchymal cell was induced into mature hepatocytes in vitro and then treated with PBS(Cont),deoxycholic acid(DCA),DCA plus UDCA(U+D)or UDCA alone(UDCA).Cell apoptosis was detected by Hoechst staining and Caspase-3 activity measurement. The mRNA expressions of D53 and Bax were measured by semi-quantitative RT-PCR and real-time RT-PCR,The Bax protein expression was detected by immunohistochemistry.Results In comparison with Cont.DCA obviously induced hepatocyte apoptosis as measured by an increased cell count and a higher Caspase-3 activity(P＜0.05).These increments could be inhibited by addition of UDCA.The expressions of p53 and Bax in hepatocytes were up-regulated by DCAThese up-expressions could also be inhibited by UDCA.The DCA-induced increased count of Bax-positive cells could be reduced bv UDCA.Conclusion UDCA inhibits DCA-induced hepatocyte apoptosis by downregulating the expression of p53/Bax signal molecule.

objective To establish the irritable bowel syndrome(IBS) rat model by the combination of acute stress and transient intestinal infection with Trichinella Spiralis(T.S.).Methods The rat model of acute cold restraint stress post-infection(PI+ACRS)was established as following:the intestinal infection with 1500 T.S.in 1 ml saline to adult male BN rats was performed at Day O by gastric lavage.Then a 2-hour stimulus of ACBS was administered at Day 100.Age matched transiently infected without stress rats(PI)and normal rats served as controls(CON)(n=6,for each).After anesthesia,all the rats underwent colonic manometry in vivo at Day 100.The colonic pressures at 3 different states (baseline for 20 min;1 ml balloon distension stimulation for 5 min and 2 ml balloon distension stimulation for 20 min)were traced with a 5-minute interval between each two.The following parameters were recorded:(1)Duration (Dur.):total time of eontractions during each state.(2)Maximum(Max.):hishest amplitude of contractional waves(mm Hg).(3)Area:area under contraction waves.(4)Number (Num.):frequencies of contraction wave during each state.The visceromoter response to colorectal distension(CRD)was analyzed at Day 100 post-infection.And the distension volume of AWR 3 was detected for 5 times with a 20-min interval in each rat. Results The histological damage of intestine induced by T.S.infection is transient. Although such acute infectious features as epithelial edema,hyperemia and marked eosinophil infiltration appeared at Day 10 PI,the histological changes almost recovered at Day 100 PI in both the PI group and the PI+ACRS group.Both the stimuli of transient infection and the ACRS postinfection induced intestinal dysmotility and visceral hypersensitivity.The ACRS post infection further worsened the transiently induced infection.The parameters of Num.Max and Area in the PI+ACRS group were all significantly higher than those of the PI group[Max:(41±17)mm Hg vs (22±6)mm Hg,P=0.000;Area:(7693±2822) mm Hg·s vs (5092±1687)mm Hg·s,P=0.000;Num:9.5±2.6 vs6.6±3.1,P=0.000];so was the distension volume of AWR3[(2.25±0.29)ml,vs(2.52±0.32)ml,P=0.004].As compared with the range of normal values from controls,the abnormality rates of motility parameters and visceral threshold in PI +ACRS group also had an larger increment than those of the PI group (PI+ACRS:50.0%-87.5%and 100%respectively,PI:25.0%-37.5%and 90.0%respectively).Conclusion The pathophysiological changes in the PI+ACRS rats are consistent with those of IBS.Aggravated by psychological factors.these rats reproduce the symptoms of intestinal dysmotility and visceral hypersensitivity.A proper animal model has been established for the investigation of IBS.

Bone metastasis of prostate cancer (PCa) is a common clinical problem, and bone metastasis has many pathological manifestations. Pathological fractures, spinal cord compression, hypercalcemia and bone complications that require surgical treatment or radiotherapy are collectively referred to as bone-related events (SRE) in the literature [1-2]. Most PCa patients have a long survival time, and about 70% of them will develop bone metastasis during the course of disease progression. The 5-year survival rate of PCa patients with bone metastasis is 25%, and the median survival time is 3 years [3]. During such a long survival period, the health-related quality of life (ItRQOL) of patients will be severely decreased due to SRE caused by bone metastasis.

Circulating DNA is an extracellular nucleic acid that exists in human body fluid. At present, circulating DNA has been detected in plasma and serum. With the continuous deepening of the research on circulating DNA, it has been found that circulating DNA is closely related to the development of many diseases, which provides new ideas for diagnosing diseases and monitoring the therapeutic effect.

Osteoporosis is a systemic skeletal disease caused by multiple microgenes and environmental factors, and is characterized by decreased bone mass and increased fracture risk. Twin and family studies estimated that 65% ~80% of the variation of peak bone mineral density (BMD) is determined by genetic factors [1]. It was also found that many factors that determine fracture risk are also affected by genetic effects, including bone mass, quantitative ultrasound (QUS), geometric parameters of femoral neck, bone turnover markers, etc.

Ureteral soft spot disease is rare in clinic, difficult to diagnose before operation, and the clinical symptoms and imaging manifestations are often confused with ureteral carcinoma. A total of 3 cases were treated in the Department of Urology of Beijing Anzhen Hospital affiliated to Capital Medical University from September 1998 to February 2005, and are reported as follows. 　　

Objective To isolate and culture the neural stem cells(NSC)from rat's fetus brain,to study the transfection efficaey of NSC using electroporation.Methods We isolated.cultured and amplified NSC from the brain of SD fetal rats.NSC and differentiated cells were identified using immunofluoreseent histochemicai methods.Using green fluorescence protein (GFP)as the marker.pEGFP-NI was transfected into NSC using electroporation.and the tranfection rate was calculated by counting the NSCs with green fluorescent.Results The cells isolated from brain tissue of fetal rats can proliferate for long time.both primary and passage culture of NSC can express specific antigen of NSC-Nestin.and after induced differentiation,the cells can express specific antigen of astrocytes-Glial fibrillary acidic protein(GFAP) and specific antigen of neurons-Neuron-specific enolase(NSE).The tranfection rates of electroporation were17.9%-69.1%.the average was 30.5%.Conclusion Isolated NSC which had the features of selfprollferation and differentiation potential from brain tissue of SD fetal rats,confirmed that electroporation was an efficient transfection method for NSC.provided experimental basis for gene therapy in the future.

The patient was a 45-year-old female, a civil servant. She was admitted to the hospital on September 9, 2008. The patient was admitted to a hospital in Tianjin after physical examination 3 months ago. After admission, the chest CT examination showed nodules with increased density and irregular periphery in both lungs (Figure 1). The lesions were not improved after anti-inflammatory treatment. Because the imaging did not exclude lung cancer, she underwent local resection of the lesions in the left lower lobe of the lung in July 2008. Pathological report: proliferative tuberculosis in the left lower lobe of the lung, congestion of lung tissue and small bronchiectasis. After half a month of anti-tuberculosis treatment, she still complained of cough and fever, and her body temperature was 37.2~37.3℃. After reexamination of the chest CT, there was no obvious change in the nodule shadow in the right lung, but the changes in the left lung after operation. She was transferred to our hospital for reexamination of lung histopathology.

The patient was a female, born in October 2004, from Hunan. She was born by caesarean section at full term. Her birth weight was 3.2 kg, and she had no history of hypoxia and asphyxia. She would raise her head at 3 months, and she could talk and walk at the age of 1. After birth, she found that the child had thin skin, thin hair and dark color. With the increase of age, the hair became thinner and yellow, and the subcutaneous fat gradually shrank and decreased. Her language, motor and intellectual development were normal. Her diet, sleep, urine and defecation were normal. She went to our room on February 18, 2009. Physical examination showed that her height was 82.5 cm, weight was 9.5 kg, and head circumference was 47.5 cm.

For patients with acute coronary syndrome with or without ST segment ascending, the current clinical treatment guidelines recommend dual antiplatelet therapy with aspirin and clopidogrel. The efficacy of clopidogrel is limited because of its slow onset of action, easy conversion to other active metabolites, increased risk of hemorrhage, thrombosis and myocardial infarction. Compared with clopidogrel, another thymine metabolite, ticagrelor, has a more durable and definite platelet inhibitory effect, and reduces the risk of myocardial infarction and thrombosis. Ticagrelor, a reversible, direct-acting, oral antagonist of adenosine diphosphate receptor P2Y12, has a more sustained inhibitory effect on P2Y12, and has a faster onset of action and a wide range of action than clopidogrel.

Published online October 8, 2009<New England Journal of Medicine reported the results of studies on hospitalized or severe influenza A (H1N1) patients in China by Australian and New Zealand scholars (http: / /content.nejm.org/cgi/content/full/NEJMoa0908481) and American scholars (http: / /content.nejm.org/cgi/content/full/NEJMoa0906695). The data provided a reference for the preparation of ICU to deal with the winter influenza epidemic in the Northern Hemisphere. Since the epidemic situation of influenza A in China is still developing and the number of severe cases is increasing, it is of practical significance to pay attention and understand the diagnosis and treatment of severe patients abroad.