Volume 92  ·   Issue 14  ·  2012

Since the first Global Initiative for Chronic Obstructive Pulmonary Disease (COPD) (GOLD) report-Global Strategies for Diagnosis, Treatment and Prevention of COPD was published 10 years ago, the initiative has been revised many times, and quite a few contents have been updated. The contents of this revision are mainly based on the new research results and related new knowledge of COPD. @ @ I. Definition and Classification of COPD

The pathogenesis of chronic obstructive pulmonary disease (COPD) is complex, and there is no effective drug to prevent its progression. Why can't the airway inflammatory response of COPD stop with smoking cessation? Why does hormone resistance develop? In recent years, while trying to answer the above questions, people have paid more attention to: Is there bacterial colonization in the airway? If a potential viral infection can amplify the inflammatory response caused by tobacco, will colonizing bacteria also have a role? Although some autoantibodies are found in lung tissue and serum of COPD patients, is COPD an immune disease? If not, what do these antibodies do?

Entrusted by the editorial department of Chinese Medical Journal, we are very honored to invite three experts, J (φ) rgen Vestbo, Chairman of the Scientific Committee of the Global Initiative for Chronic Obstructive Pulmonary Disease (COPD) (GOLD), Suzanne S Hurd, Scientific Director of GOLD, and Roberto Rodriguez-Roisin, Chairman of the Executive Committee of GOLD, to give a wonderful overview of the update of GOLD in 2011 on behalf of the Scientific Committee of GOLD. The 2011 edition of GOLD has made many revisions in content, which brings new ideas and challenges for the diagnosis and treatment of COPD.

Objective To evaluate the effects of shadow boxing training on the exercise endurance and quality of life of Chinese patients with COPD (chronic obstructive pulmonary disease).Methods From May 2010 to March 2011,a total of 70 COPD patients in stable phases were recruited from Liwan,Yuexiu and Haizhu districts of Guangzhou. There were 35 patients in the shadow boxing exercise group and 35 patients in the control group.And they were matched by gender and age.The patients in the shadow boxing group exercised for 3 months while those in the control group received the conventional out-hospital management only.Their demographic,medical history,smoking status,medicinal use,spirometric data,clinical COPD questionnaire (CCQ) scores,6-minute walking distance and Borg scores were collected before and after trial.Results A total of 63 COPD patients (33 in shadow boxing group vs.30 in control group) completed the study.There was an average dropout rate of 5.7％ (2/35) in shadow boxing group and 14.3％ (5/35) in control group.No differences existed between two groups in age (67±8 vs 69±9 yr),male proportion (84.8％ vs 86.7％),body mass index (22.8±2.6 vs 22.7±3.0),usage proportion of medicine (42.4％ vs 33.3％),duration of disease (4.0±7.5 vs 5.5±7.3),percentage of smokers (78.8％ vs 80.0％),6-minute walking distance (447±94 vs 414±100),CCQ total score (15.0±9.4 vs 14.1±8.8),CCQ symptom score (9.2±5.6 vs 8.3±5.0) and activity score (5.8±4.5 vs 5.8±4.4)at baseline (all P＞0.05).At the end of study,the 6-minute walking distance of patients had statistical differences between two groups (P＜0.01).The shadow boxing group increased by (51±55) m while the control dropped by (19±58) m.The total score,symptom score and activity score of clinical COPD questionnaire had statistical differences between two groups. They decreased significantly in the shadow boxing group as compared with the baseline data while there was no significant change in the control group.No statistical differences existed between two groups in the changes of forced vital capacity (FVC),forced expiratory volume in one second (FEV1),FEV1％ pred,Borg score and dyspnea scales.Conclusion Capable of improving the exercise endurance and life quality of COPD patients,shadow boxing exercise may become one of effective rehabilitation programs for COPD patients in stable phases in communities.

Objective To conduct a preliminary proteomic study of chronic obstructive pulmonary disease (COPD) with peripheral skeletal muscle atrophy.Methods A total of 16 COPD patients and 8 aged-matched persons because of bone fractures were recruited in First Hospital Affiliated to Kunming Medical College from February to July in 2010. According to body mass index,fat free mass index,quadriceps femoris perimeter and quadriceps femoris active contraction,they were divided into those with muscle atrophy (group A,n=8) and those without (group B,n=8).There were 6 males and 2 females with an average age of (70±8) years in the group A and 5 males and 3 females with an average age of (74±8) years in the group B. And the control group had 6 males and 2 females with an average age of (72±6) years.All samples of total quadriceps protein were separated by two-dimensional gel electrophoresis.The abnormal protein points on electrophoresis were compared by PDQuest image software.And the differential protein expression was detected. Then the corresponding peptide quality fingerprint spectrum was analyzed by mass spectrometer.Finally the differential protein points were partially detected by a search of database.Results The two-dimensional gel electrphoresis yielded an excellent profile of resolution and repeatability.And 12 proteins likely to cause skeletal muscle atrophy in COPD were identified.Among them,8 proteins belonged to structural proteins (actin alpha cardiac muscle isoform CRA_c,myosin regulatory light chain 2,ventricular/cardiac muscle isoform,myoglobin isoform myosin heavy polypeptide 7 cardiac muscle beta isoform CRA_c,actin,alpha skeletal muscle,actin alpha cardiac muscle isoform CRA_b,hemoglobin alpha 1 globin chain & myosin light chain 6B) and 4 proteins were of functional proteins (chain A,crystal structure of human enolase ; troponin T,slow skeletal muscle isoform alpha,carbonate anhydrase,troponin T & slow skeletal muscle isoform b).Conclusions COPD patients are often accompanied with obvious peripheral skeletal muscle atrophy. It may be caused by quantitative or qualitative changes of peripheral skeletal structural and functional proteins.

Objective To explore the incidence of comorbidities in hospitalized chronic obstructive pulmonary disease (COPD) patients and influencing factors.Methods A rctrospective review of medical records was performed for 495 hospitalized COPD patients in Peking University Third Hospital from Januray 2003 to December 2008.Their commorbidities were identified and ranked in prevalence.The risk factors of commorbidities were analyzed by multivariable Logistic regression.Results The most frequent comorbidities were:hypertension (60.0％),ischemic heart disease (16.0％),malignant tumor (10.9％),diabetes mellitus (10.5％),chronic heart failure (9.9％) and dyslipidemia (9.9％).The percentage of patients with ischemic heart disease in people with FEV1％ Pred＜30％,30％≤FEV1％ Pred＜50％,50％≤FEV1％ Pred＜80％ and FEV1％ Pred≥80％ were 9.2％,12.7％,21.3％ and 16.5％ respectively (P=0.052 ). The percentage of patients with dyslipidemia in people with FEV1％ Pred＜30％,30％≤FEV1％ Pred＜50％,50％≤FEV1％ Pred＜80％,FEV1％ Pred ≥80％ were 5.3％,5.7％,10.9％ and 20.3％ respectively (P=0.002).The percentage of patients with ischemic heart disease in people with body mass index (BMI) ＜18.5,18.5-23.9,24.0-27.9,≥28.0 kg/m2 were 13.6％,14.2％,14.6％ and 28.3％ respectively (P=0.051).The percentage of patients with dyslipidemia in people with BMI＜18.5,18.5-23.9,24.0-27.9,≥28.0 kg/m2 were 5.5％,5.7％,14.6％ and 25.0％ respectively (P=0.000).The levels of C-reactive protein (CRP) were higher than the 75th percentile (OR=2.371,P=0.014),and complications with metabolic syndrome (OR=2.694,P=0.003) were independent risk factors of ischemic heart disease in COPD patients.Conclusions The incidence of comorbidities varies in different COPD populations.Higher levels of CRP and complications with metabolic syndrome are independent risk factors of ischemic heart disease in COPD patients.

Objective To deepen the understanding of patients with seminal vesicle cyst to facilitate its correct diagnosis and treatment.Methods Five patients with seminal vesicle cysts were treated during January 1996 to May 2010.Their symptoms,diagnostic results,treatments and outcomes were analyzed retrospectively.Their mean age at diagnosis was 35 years old (range:20-45).The symptoms included hematospermia (n=3),urinary frequency (n=3),perineal malaise (n=4),infertility (n=3),postejaculation pain (n=3),scrotal pain (n=3) and dysuria (n=1).Cyst was palpable on digital rectal examination in 4 patients. All underwent intravenous urography and cystoscopy. Others received the examinations of ultrasonography,computed tomography (CT) scanning,magnetic resonance imaging (MRI) and vasovesiculography.The size range of masses was from 3.8 cm×3.0 cm×2.6 cm-9.6 cm×5.2 cm×5.0 cm.Final open operations consisted of vesiculectomy (n=2) and laparoscopic excision of seminal vesical eyst (n=3).Results The post-operative course was uneventful except in 1 patient with damaged ureters.All patients stayed symptom-free after open surgery.Conclusion Seminal vesicle cysts are rare but should be considered in males with hematospermia and otherwise inexplicable bladder irritation symptoms,perineal discomforts or other genitourinary complaints of unknown etiology.The diagnostic modalities consist of digital rectal examination,transrectal and abdominal ultrasonography,CT scan or MRI. Laparoscopic excision offers excellent outcomes.

Objective To explore the risk factors of fungal infection so as to provide rationales for the prevention of fungal infection after liver transplantation.Methods The clinical data of 94 cases of fungal infections after liver transplantation from January 1,2003 to November 30,2010 at our hospital were collected as the infective group.A total of 603 liver transplant patients without fungal infections during the same period were selected as the control group.x2 test and t test were utilized for the analysis of possible risk factors for fungal infection.Results Fungal infection rate was 13.5％(94/697) after liver transplantation and mortality rate of fungal infection 86.2％(81/94).Candida albicans was the majority infective fungi.And the main site of infection was the lungs. The postoperative acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ) score of the infective group was significantly higher than that of the control group (26.0±5.4 vs 21.5±4.7,P＜0.01).The number of patients with primary liver cancer was lower than that of the control group(26.6％ vs 45.8％,P＜0.01).The number of decompensated HBV cirrhosis and diabetics in the infective group was higher than that of the control group at pre-operation (23.4％ vs 11.6％,9.6％ vs 2.8％,both P＜0.01).The number of patients with postoperative mechanical ventilation over 10 days,postoperative antibiotics over 14 days,postoperative cardiopulmonary dysfunction and liver function recovery time over 7 days,parenteral nutrition over 12 days and hyperglycemia over 7 days in the infective group were significantly higher than that in the control group (all P＜0.01). Conclusion Preoperative primary disease,postoperative disease severity,postoperative organ dysfunction,long-term mechanical ventilation,antibiotics and hyperglycemia,etc. may be the important risk factors of fungal infection after liver transplantation.

Objective To explore the efficacy and safety of radiofrequency catheter ablation (RCA) for ventricular premature beats originating from left coronary sinus under the guidance of 3-dimensional mapping system (CARTO). Methods A total of 15 patients with premature ventricular contractions (PVCs) originating from left coronary sinus underwent CARTO-guided RCA.Anatomical structurcs were constructed and three-dimension (3D) electrical activation sequence was plotted for left ventricle and aortic sinus.The distance of earliest activation point of PVCs and origin of left coronary artery were surveyed after left coronary arteriography.Results The electrocardiogram (ECG) results showed that R-wave was upward in leads Ⅱ,Ⅲ and avF,QRS waves in lead Ⅰ was mainly of rS,rs and rsr types,QS type in lead avL,RS,Rs and rS type in lead V1,RS type in lead V3 and absence of S wave in lead V5/V6.Intraoperative mapping detected the earliest activation point on the posterio-inferior origin of left coronary artery (LMCA) ostium (n=7),on the anterio-inferior of LMCA ostium (n=3) and on the inferior of LMCA ostium (n=5). The earliest activation point (local activation time) was shorter 86-120 ms than surface electrocardiogram QRS wave,discharge melting on the earliest activation point and nearby succeeded.PVCs disappeared,PVCs failed to be induced under similar preoperative conditions (aleudrin intravenous) and no complication occurred intraoperatively and postoperatively.Conclusion The CARTO-guided RCA is a safe and effective in the treatment of PVCs originating from left coronary sinus.

Objective To compare the outcmes of minimally invasive coronary artery bypass grafting operation performed via a small thoracotomy versus da Vinci S system (Endo-A-CAB) with sternotomy off-pump coronary artery bypass grafting (OPCAB) for single vessel lesion.Methods From April 2000 to August 2011,a total of 194 patients with single coronary artery stenosis accepted CABG on beating heart were divided into 2 groups by different surgical approaches. Group A (n=99) reccived sternotomy OPCAB while Group B (n=95) underwent Endo-A-CAB.All patients had a history of unstable angina and coronary arteriography showed severe stenosis in left anterior descending artery (LAD).The procedure performed in Group B included robotic internal mammary artery (IMA) harvesting and single manual anastomosis to LAD and/or diagonal branch through small incision thoracotomy. IMA flow was evaluated by the Doppler flow meter after the completion of anastomosis. Grafting patency was evaluated postoperatively by computed tomography angiography (CTA) or angiography.Results The ventilation time and postoperative drainage volume in Group B were less than those in Group A ((5.1±2.1)vs(10.1±5.8)h,P=0.03;(411±295)vs(605±244)ml,P=0.000).No significant difference existed in blood flow,mortality and postoperative complication morbidity between two groups. All symptoms of angina disappeared.Conclusion As a new advanced modality of revascularization,in comparison with OPCAB,Endo-A-CAB procedure is a less invasive and safer method of coronary artery bypass grafting for single vessel lesion.

Objective To evaluate the safety and efficacy of pitavastatin in patients with hypercholesterolemia in China under conditions of extensive usage.Methods This was a 12-week,multicenter,open-label,without parallcl-group comparison,phase Ⅳ clinical trial.Results There were 427 subjects in the safety set.The adverse events mainly included vomiting,myalgia and the elevations of aspartate transaminasc (AST),alanine transaminase (ALT) and creatine kinase (CK),etc.The incidence of drug-related adverse events was 4.22％.There were no significant differences between pre-exposure and post-exposure average levels of renal function indicators and blood routine examination item (all P＞0.05).None of them had a high AST/ALT value,i.e.＞3 times upper limits of normal (ULN),or had a high CK value,i.e.＞10 times ULN.There were 397 subjects in the per protocol set.At week 12 post-treatment,the blood levels of total cholesterol and low density lipoprotein cholcsterol(LDL-C) in subjects without previous treatment decreased 24.6％ and 31.0％ respectively,that of high density lipoprotein cholesterol (HDL-C) in subjects with HDL-C ＜1.04 mmol/L increased 60.1％ while that of triglyceride (TG) in subjects with TG ＞1.70 mmol/L decreased 22.5％ (P＜0.05).And 207 (92.3％) subjects were at a low risk,46(76.1％) subjects at an intermediate risk,134(47.8％) subjects at a high risk and 10(40.0％) of subjects at a very high risk had achieved a LDL-C target value; the LDL-C goal achievement rate after switching from previous medication to pitavastatin was significant higher than that of pre-switching.Conclusion Pitavastatin demonstrates positive safety and efficacy.It may be used for the treatment of patients with hypercholesterolemia in China.

Objective To explore the role of NOTCH1/HES1/PTEN signaling pathway in invasive TCCB (bladder transitional cell carcinoma).Methods The expressions of NOTCH1,HES1 and PTEN were detected in 36 cases of invasive TCCB tissues and 10 cases of normal bladder samples by real-time q-polymerase chain reaction (q-PCR) and Western blot. Then NOTCH1-ORF plasmid and its blank vector pCMV6-Entry were transfected into T24 cell respectively. And the expressions of three above-mentioned target genes were measured by real-time q-PCR and Western blot. Furthermore,cell proliferation,cell apoptosis and cell cycle were analyzed respectively by MTS assay and flow cytometry.Results Compared with normal bladder samples,the higher levels of both mRNA and protein of NOTCH1 and HES1 were detected in invasive TCCB tissues while there was a lower expression of PTEN (P＜0.05).The mRNA expression levels of NOTCH1 and HES1 were 4.22 and 3.75 folds respectively higher than those of normal tissues.In NOTCH1-overexpressed T24 cell,the expression of HES1 was 5.43 folds higher than that of the blank vector control group while the expression of PTEN declined to 41.76％ (P＜0.01).MTS assay showed that the NOTCH1-ORF transfection obviously promoted cell proliferation in T24 cell (P＜0.01).Conclusion NOTCH1 gene may function as an oncogene by regulating HES1/PTEN in invasive TCCB and its aberrant activation promotes cell proliferation.

Objective To determine the risk factors for respiratory intensive care unit (RICU)-acquired colonization of multidrug-resistant Acinetobacter baumannii (MDR-AB).Methods From January 2010 to June 2011,active screening was performed to define patients with RICU-acquired colonization of MDR-AB.And environment surveillance was carried out and patient data were collected.Logistic regression was applied to identify the risk factors of RICU-acquired colonization of MDR-AB. Results Active screening for MDR-AB was performed for 110 patients in RICU and 50 patients turned out to be positive.After eliminating 3 input positive patients,the RICU-acquired colonization rate of MDR-AB was 43.9％ (47/107).The environmental contaminated rate of MDR-AB was 66.0％ (31/47)for 47 positive patients and 33.9％ (19/56) for 56 negative ones (x2=10.494,P＜0.01).Five risk factors were associated with the colonization of MDR-AB through univariate analysis:consciousness disturbance,use of carbapenems,nasal feeding tube,endotracheal intubation and mechanical ventilation (all P＜0.05). The Logistic regression equation contained 3 risk factors of conscious disturbance,use of carbapenems and mechanical ventilation (OR=3.412,3.211,3.002; 95％ CI:1.165-9.992,1.117-9.233,1.101-8.182).Conclusion Three risk factors are independently associated with the RICU-acquired colonization of MDR-AB:consciousness disturbance,use of carbapenems and mechanical ventilation.

Objective To study the expressions of phosphorylated STAT5 (P-STAT5) in CD34+ CD59- and CD34+ CD59+ bone marrow cells of the patients with paroxysmal nocturnal hemoglobinuria (PNH) before and after in vitro G-CSF or SCF stimulation,then evaluate the functions of G-CSF and SCF receptors in PNII clone cells.Methods Bone marrow mononuclear cells (BMMNC) of 26 PNH patients and 14 normal controls were stimulated in vitro with G-CSF (100 ng/ml) or SCF (100 ng/ml) for 10 min.Before and after these stimulations,the mean fluorescence intensity (MFI) of P-STAT5 in CD34+ CD59+ BMMNC and CD34+ CD59- BMMNC were measured by flow cytometry.Results (1) The P-STAT5 MFI was (24±18) in unstimulated CD34+ CD59- cells.And it was significantly lower than that in unstimulated CD34+ CD59+ cells of PNH patients (64±49) and normal controls (61±33) (both P＜0.01).No statistic difference existed between the latter two.(2)The P-STAT5 MFI was (36±35) in G-CSF stimulated CD34+ CD59- cells of PNH patients.And it was significantly lower than that in G-CSF stimulated CD34+ CD59+ cells of PNH patients (124±84) and normal controls (116±59) (both P＜0.01).There was no statistic difference between the latter two.(3)The P-STAT5 MFI was (34±27) in SCF stimulated CD34+ CD59- cells of PNH patients.And it was significantly lower than that in SCF stimulated CD34+ CD59+ cells of PNH patients (124±97) and normal controls (128±62) (both P＜0.01).And no statistic difference existed between the latter two.(4)The incrcased P-STAT5 MFI in G-CSF stimulated CD34+ CD59- cells of PNH patients was significantly lower than that in G-CSF stimulated CD34+ CD59+ cells of PNH patients and normal controls (both P＜0.01).No statistic difference existcd between the latter two.The increase of P-STAT5 MFI in SCF stimulated CD34+ CD59- cells ofPNH patients was significantly lower than that in SCF stimulated CD34+ CD59+ cells of PNH patients and normal controls (both P＜0.01).No statistic difference existed between the latter two.Conclusion There is a lower expression of P-STAT5 expressed in G-CSF or SCF stimulated PNH clone cells compared to that in normal clone cells.

Objective To explore the protective effects and possible mechanism of lipoxin A4-methyl ester (LXA4-ME) in rats with acute pancreatitis (AP).Methods A total of 120 male SD rats were randomly divided into 3 groups:Sham operation (n=40),AP (n=40) and LXA4-ME (n=40).Sham operation group received normal salinc aftcr sham operation.AP was induced by a retrograde infusion of 5％ sodium taurocholate into pancreatobiliary duct. AP group received normal saline after modeling. In the LXA4-ME group,LXA4-ME was administered (87.5 μg/kg) intraveneously after the onset of AP.The rats were sacrificed at 12 h and 24 h post-induction.Their serum levels of amylase were detected.The amount of ascites was calculated and histological changes of pancreas were observed.The activities of myeloperoxidase (MPO) and levels of malonaldehyde (MDA) in pancreas were determined.The mRNA levels of tumor necrosis factor (TNF)-α,interleukin (IL)-1β,IL-10,intercellular adhesion molecule (ICAM-1),E-selectin and nuclear factor (NF)-κB p65 in pancreas were measured by reverse transcription-polymerase chain reaction (RT-PCR) . The expression of NF-κB p65 protein was also measured by immunohistochemistry.Results Compared with the AP group,the pathological scores of the LXA4-ME group improved ( 12 h:8.7±1.3 vs 11.3±1.5,24 h:7.8±1.1 vs 11.7±0.8 ) and the amount of ascites was lower(12 h:(6.88±1.23) ml vs (12.32±1.94) ml,24 h:(6.53±0.91) ml vs (14.15±1.68)ml,all P＜0.01 ).The serum levels of amylase in the LXA4-ME group were significantly lower than those in the AP group respectively at 12 h and 24 h post-operation (all P＜0.01).The activity of MPO and the level of MDA in pancreas in the LXA4-ME group were significantly lower than those in the AP group ( all P＜0.01 ).The pancreatic expressions of TNF-α mRNA,IL-1β mRNA,ICAM-1 mRNA,E-selectin mRNA and NF-κB p65 mRNA at 12 h and 24 h decreased in the LXA4-ME group versus the AP group at the corresponding timepoints( all P＜0.01 )while the expression of IL-10 mRNA increased versus the AP group at the corresponding timepoints ( all P＜0.01 ).Compared with that in the AP group,the pancreatic expression of NF-κB p65 protein decreased in the LXA4-ME group (12 h:24.8％±3.0％ vs 45.3％±3.4％,24h:31.6％±3.0％ vs 48.1％±4.6％,both P＜0.01).Conclusion LXA4-ME exerts protective effects in AP rats.And its mechanism may be due to the suppression of NF-κB activation

Objective To explore the protective effects of N-acetylcysteine (NAC) on cochlear damage occurring in irradiated guinea pigs.Methods Seventy-two guinea pigs were randomly divided into 4 groups (n=18 each).Control group received neither NAC nor irradiation,irradiation group received total cranium irradiation of 70 Gy,irradiation & saline group cranium irradiation of 70 Gy and saline solution through a round window and NAC group cranium irradiation of 70 Gy and NAC through a round window.The right ear received radiation.The animals were sacrificed at Day 14 post-irradiation.The specimens were dehydrated, embeded in paraffin and serially cut into 5-μm slices. Sections were stained with immunohistochemistry and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL).The cochlear basal membranes were observed for malondialdehyde (MDA) and superoxide dismutase (SOD) with scanning electron microscope.Results The cilium of hair cells had uo clear loss and apoptotic number of spiral ganglion cells decreased in NAC group.The average optical density value of Caspase 3 in spiral ganglion in NAC group significantly decreased versus the irradiation group ( 0.08±0.02 vs 0.10±0.01,P＜0.01 ).The level of MDA of NAC group also decreased versus the irradiation group ( 0.33±0.05 vs 0.84±0.13,P＜0.05 ).The level of SOD in the NAC group increased versus the irradiation group ( 10.7±3.0 vs 8.7±1.3,P＜0.05 ).The ratio of apoptotic cell in SGC in the NAC group at Day 14(7.8％±1.8％) decreased versus the irradiation group (32.0％±8.7％) at Day 14.Conclusion MDA and SOD may be involved iu the pathogenesis of cochlear cell damage. And NAC protects the irradiated cochlear cell.

Objective To explore the role and mechanism of motilin in colonic motility disorder.Methods A total of 20 male Wistar rats (180-200 g) were randomly divided into 2 groups:water avoidance stress (WAS,n=10) and sham water avoidance stress (SWAS,n=10).Rats were exposed to 1 h WAS or SWAS daily for 10 consecutive days.Motilin in plasma was measured by enzyme-linked immunosorbent assay (ELISA).Proximal colon circular smooth muscle cells (PCSM) were isolated by enzymatic digestion and L-type calcium currents (ICaL) recorded by patch-clamp techniques.Results The fecal pellets during 1 h WAS significantly increased (5.4±1.0 vs 2.4±0.7,P＜0.01,n=10).The motilin in plasma had significant difference between WAS rats and SWAS rats ( (135±35) vs (89±24)pg/ml,P＜0.01,n=10).The ICaL of two rats had no significant difference.But 6×10-5 mnol/L motilin increased ICaL more in WAS than in SWAS rats at 0 mV ( (1.6±0.4) vs (1.0±0.3) pA/pF,P＜0.05,n=10 ).Conclusion WAS leads to elevated motilin levels in plasma and active L-type Ca2+ channels in colon.And it contributes to colonic motility disorder.

Pancreaticoduodenectomy is an effective radical surgical procedure for periampullary carcinoma and pancreatic head carcinoma. Due to the particularity of tumor site and different specific conditions during operation, there is no reconstruction method that can satisfy all patients [1-2]. From January 2009 to May 2011, the Department of General Surgery of Henan Cancer Hospital treated 10 patients with lower common bile duct carcinoma that invaded upward to the common hepatic duct or even near the bifurcation of the left and right hepatic ducts, and performed pancreaticoduodenectomy with single interposed jejunum, with satisfactory results, which are summarized as follows.

adiponectin (APN) is the only adipocytokine that has been found to be negatively correlated with body fat content. Clinical research data show that the decrease of plasma APN is closely related to the occurrence, development and prognosis of diabetes, cardiovascular diseases, etc. Plasma APN is rich in content and stable in structure, and has multiple functions such as insulin sensitization, anti-inflammatory, protective and vascular effects. Therefore, APN is not only a biomarker with potential clinical application value for disease prevention and prognosis evaluation, but also is expected to be a new target for the treatment of diabetes/metabolic syndrome and cardiovascular diseases. However, APN in circulating blood has short half-life, high concentration and complex molecular subtypes, which bring challenges to its clinical application. This paper reviews the biological role and clinical application prospect of APN.

acute respiratory distress syndrome (ARDS) is a severe stage of acute lung injury (ALI), often complicated with multiple organ failure, and the mortality rate is about 50% [1-2]. In recent years, people have been continuously exploring its pathogenesis and treatment scheme [1, 3-4]. profluorocarbon (PFC) is a kind of compound obtained by substituting hydrogen atom in hydrocarbon with fluorine atom. It is a colorless and transparent liquid at room temperature, with high density, low surface tension, no catabolism in vivo, and strong oxygen carrying capacity.

Sponsored by Chinese Medical Association and Chinese Medical Journal and hosted by Tianjin Medical University General Hospital, the Advanced Symposium on Diabetes and Cardiac, Brain, Renal and Peripheral Vascular Diseases was held in Tianjin Medical University General Hospital on August 27-28, 2011. Nearly 20 well-known experts in the fields of endocrinology, cardiovascular diseases, nephrology and neurology, such as Academician Gao Runlin and Academician Liu Zhihong, were invited to report on the latest progress of basic and clinical research on diabetes and its complications. More than 300 delegates from all over the country attended the conference. The main contents of the conference are reported as follows.