Volume 92  ·   Issue 38  ·  2012

Thrombosis is the main cause of cardiovascular events and plays an important role in the occurrence and development of coronary heart disease. Many clinical studies have shown that antiplatelet drugs can improve the prognosis of patients with coronary heart disease. However, the recurrence rate of cardiovascular ischemic events is still as high as 9.3% ~12.1% in double antiplatelet therapy. In addition, antiplatelet drugs cause hemorrhage events in some patients. Therefore, the research and development of new antiplatelet drugs and evaluation of efficacy and safety of antithrombotic drugs have become the research hotspot in the field of coronary heart disease treatment.

Unprotected left main trunk (UPLM) lesions account for 3% ~5% of coronary intervention cases. In the era of balloon dilatation, UPLM lesions are considered to be a contraindication for interventional therapy, because the mortality rate of UPLM treatment with balloon dilatation alone can be as high as 50%. After stent enters clinical application, although coronary artery bypass grafting (CABG) is still the first choice of treatment, percutaneous coronary intervention (PCI) with stent has become an important treatment for selective UPLM patients in practical clinical work, and it has also achieved satisfactory long-term efficacy.

In 2007, the American Heart Rhythm Society (HRS), European Heart Rhythm Association (EHRA) and European Arrhythmia Association (ECAS) jointly published the first expert consensus on catheter and surgical ablation of atrial fibrillation (AF) [1]. In recent years, the understanding of AF ablation has been increasing, and some changes have been made in the indications. In 2012, the "Expert Consensus on Catheter and Surgical Ablation of AF" jointly published by HRS, EHRA and ECAS was published in Heart Rhythm, Europace and J Interventional Cardiac Electrophysi journals. This consensus was also endorsed by the American College of Cardiology (ACC), American Heart Association (AHA), Asia Pacific Heart Rhythm Society (APHRS) and Association of Thoracic Surgery (STS).

Objective To evaluate the efficacy and safety of intra-aortic balloon pump (IABP)counter pulsation in the treatment of ST-segment elevation myocardial infarction (STEMI) with concurrent left main coronary artery (LMCA) disease.Methods A retrospective analysis was performed on 305 patients with confirmed STEMI due to LMCA occlusion ( ≥ 50％ ) by coronary angiography.They were divided into IABP and non-IABP groups according to the application of IABP or not.Two groups were further divided into 2 subgroups according to the treatment with percutaneous coronary intervention (PCI) or drug alone.Short and long-term clinical efficacies and the incidence of complications caused by the application of IABP were analyzed in all groups and subgroups.Results ( 1 ) PCI procedure:Successful rate of immediate post-procedure was 100％.No death,major cardiovascular event and cerebrovascular accident occurred during the procedure.The average number of stents per patient was 2.1 ± 0.7 and the average diameter and length of stent were(3.9 ±0.6)and (24.2 ±7.1 ) mm respectively.(2) Safety:No significant difference existed between the IABP and non-IABP groups in in-hospital massive bleeding rate (0.94％ vs 1.00％,P ＞0.05).However,the IABP group had a higher prevalence of mild in-hospital bleeding than the non-IABP group.(3) In-hospital and long-term major adverse cardiac event (MACE) rate:① IABP group had a lower MACE rate (25.3 ％ (24/95) vs 38.5％ (57/148),P ＜ 0.05 ).②In spite of IABP implantation,the PCI subgroup had significantly a lower mortality rate than the drug subgroup (7.2％ (6/83) vs 25.0％ (6/24),P ＜ 0.05 ).③The combined use of PCI and IABP was superior to other regimens with regards to decreasing short and long-term mortality ( 11.2 ％ ( 12/ 107 ) and 25.3 ％ (50/198),P ＜ 0.01 ).Conclusion PCI is feasible and safe for the STEMI patients with LMCA and better short and long-term efficacies may be achieved.The use of IABP in the treatment of LMCA-related STEMI reduces MACE rate and improves survival rate.

Objective To evaluate the early diagnostic value of matrix metalloproteinase-9 ( MMP-9) level on admission for ST-segment elevation myocardial infarction (STEMI),explore the relationship between MMP-9 and global registry of acute coronary events (GRACE) scores and determine the values of MMP-9 in short-term prognosis of STEMI.Methods A total of 55 STEMI patients admitted into our hospital between September 2011 and February 2012 were recruited.There were early STEMI ( ≤4h of onset,n =22) and late STEMI ( ＞ 4 h after onset,n =33).Fifty subjects of coronary artery without significant stenosis after angiography were enrolled into a control group.The plasma levels of MMP-9 in venous blood were detected with enzyme-linked immunosorbent assay (ELISA).And the GRACE risk score was used for risk assessment.The incidence of new or recurrent myocardial infarction,target vessel revascularization,cardiac death,heart failure (MACE) was recorded during a follow-up period of 6 months.Results The MMP-9 levels were significantly higher in patients with STEMI ( P ＜ 0.001 ),early STEMI ( P ＜ 0.001 ) and late STEMI (P ＜ 0.001 ) than the control group.And no statistical differences existed between early STEMI and late STEMI ( P ＞ 0.05 ).The level of MMP-9 was positively correlated with the GRACE risk score.MACE occurred in 8 [14.5％ (8/55)] patients during hospitalization and 17 [30.9％ ( 17/55 )] patients during follow-up.Receiver operating characteristic (ROC) curve analysis showed area under the curve (AUC) of on admission GRACE risk score and MMP-9 levels were 0.848 (95％ CI O.706-0.991,P =0.002) and 0.766 (95％ CI 0.575-0.957,P =0.017) respectively.ROC curve analysis showed AUC of hospital discharge GRACE risk score and MMP-9 levels were 0.737 (95％ CI 0.601-0.873,P =0.005 )and 0.711 (95％ CI 0.565-0.856,P =0.013 ) respectively.No statistical differences existed between GRACE risk score and MMP-9 levels for predicting the short-term risk of MACE (P ＞ 0.05 ).Conclusion The plasma level of MMP-9 has a higher diagnostic value for early STEMI.Positively correlated with the GRACE risk score,it is a predicator of short-term risk of MACE.

Objective To evaluate the predictive value of antiplatelet resistance assessed by whole blood electronic impedance aggregometry (EIA) for the risk of recurrent cardiac ischemic events in patients with acute myocardial infarction (AMI) who underwent coronary stenting.Methods We enrolled 109 patients with AMI,72 (66.1％ ) men and 37(33.9％ ) women with mean age (63 ± 12 )years,who were treated with aspirin and clopidogrel daily after coronary stenting.EIA used arachidonic acid ( AA ) and adenosine diphosphate (ADP) as inductors to measure platelet aggregation inhibited by aspirin and clopidogrel respectively.The subjects were divided into four groups:pure aspirin resistant group (AR,electrical impedance ＞ 0 Ω),pure clopidogrel resistant group ( CR,electrical impedance ≥ 10 Ω),dual resistant group (DR) and dual sensitive group (DS).The primary outcomes were recurrent cardiac ischemic events during the 12-month follow-up.Results Antiplatelet resistance occurred more often in patients with type 2 diabetes (P =0.027 ).The platelet counts (PLT) were higher in antiplatelet resistant groups than DSgroup (P =0.013 ).During the 12-month follow-up,the antiplatelet resistant patients had a higher incidence of recurrent cardiac ischemic events and stent thrombosis (ST) than the patients without (12.5％,10.0％,50.0％ vs 3.8％,P=0.036; 6.3％,10.0％,50.0％ vs 1.3％,P=0.000; respectively).Binary Logistic regression indicated that dual resistance remained an independent predicator of recurrence cardiac ischemic events and ST ( OR 5.99,95％ CI 1.05-34.34,P =0.045 ; OR 6.36,95％ CI 1.13-35.78,P =0.036 ; respectively).Conclusions As a physiological assessment of platelet reactivity,EIA is a convenient and accurate option for measuring aspirin resistance.Antiplatelet resistance assessed by EIA is paralleled to clinical events.Dual resistance is an independent predicator for ST and recurrence cardiac ischemic events in patients with AMI.

Objective To elucidate the effects of dual antiplatelet therapy on platelet response in acute myocardial infarction patients with chronic kidney disease.Methods From September 2011 to June 2012,a total of 195 acute myocardial infarction patients with drug eluting stent implanting were enrolled.Among them,133 cases had normal renal function and 62 cases suffered chronic kidney disease (CKD).Platelet reactivity was examined after clopidogrel 300 mg and aspirin 300 mg treatment for 24 h.High on treatment platelet reactivity (HPR) was defined as ＞ 55％ for light transmission aggreometry.Results The CKD patients had a higher incidence of diabetes mellitus ( 43.5％ ( 27/62 ) vs 24.8％ ( 33/133 ),P =0.01 ),anemia (16.1％ (10/62) vs 5.3％ (7/133),P =0.03 ) and high on treatment platelet reactivity (45.2％ (28/62) vs 28.6％ ( 38/133 ),P =0.03 ) than those with normal kidney function.Logistic regression analyses showed that CKD and diabetes mellitus were independent predictors of HPR.Prevalence of HPR was higher in CKD patients than normal kidney function patients(65.1％ ± 10.2％ vs 45.3％ ±7.8％,P ＜ 0.01 ).In subgroup analysis,testing was done before and after antiplatelet treatment.At baseline,no differences existed in platelet aggregation.However,absolute decrease in reactivity after antiplatelet treatment was significantly less in CKD patients than those with normal kidney function (63.2％± 8.6％ vs 43.2％ ± 5.2％,P ＜ 0.01).Conclusion CKD is an important contributor to apparent HPR.

Objective To analyze the distribution and treatment of aryepiglottic fold diseases.Methods The clinical data of the inpatients with aryepiglottic fold diseases at our department from January 2000 to May 2011 were retrospectively evaluated.Results Among 113 cases,there were benign (n =108) and malignant (n =5) diseases.The three major symptoms were abnormal sensation of throat (n =79),hoarseness (n =29) and throat pain (n =26).Among 108 benign cases,there were surgery under direct laryngoscopy (n =100),aryepiglottic fold hemangioma undergoing laser under indirect laryngoscopy ( n =4 ),one with cyst and another with hemangioma undergoing tumor removal via an external thyrohyoid membrane approach ( n =2 ) and inflammation of aryepiglottic fold undergoing conservative treatment (n =2).Among 5 malignant tumors,the procedures included total laryngectomy ( n =2 ) and semi-laryngectomy ( n =2).One patient had not any treatment after a definite diagnosis.Conclusion Most aryepiglottic fold diseases are benign.Their major symptoms include abnormal sensation of throat,hoarseness and throat pain.Surgery under direct laryngoscopy is performed for benign diseases while laryngectomy for malignant ones.CO2,Ho-YAG and KTP laser may also be used.

Objective To explore the therapeutic response and toxicity of neoadjuvant hormonal therapy in 125I permanent seed implantation for prostate cancer and validate the clinical efficacy of neoadjuvant hormonal therapy.Methods A total of 165 patients with T1c-T3b prostate cancer received transperineal ultrasound-guided 125I permanent seed implantation and neo-adjuvant hormonal therapy (NHT).Their median age was 79 years (range:65-88).They were randomized into 2 groups:group A (n =90,3-month NHT before 125I permanent seed implantation for prostate cancer 0 and group B (n =75,125Ⅰpermanent seed implantation).The prostate surface antigen (PSA) response rate,the change of prostate volume and the toxicities of urinary system and sexual function were observed.Results The median PSA decreased to 0.38(0.01-6.56) μg/L from 26.50(3.56-150.00) μg/L after a 3-month neoadjuvant hormonal therapy and the median prostate volume dropped from 29.33 (23.62-65.21 ) ml from 46.38 ( 19.28-128.10) ml during a follow-up period of 24 months.After brachytherapy,the PSA level was maintained at a relatively low level ( median number of 0.62 μg/L and 2.56 μg/L in groups A and B respectively).And 6 and 9 patients suffered from acute urinaryretention after brachytherapy in groups A and B respectively.Conclusion Neoadjuvant hormonal therapy can reduce the volume of prostate before brachytherapy and serum PSA in a short time.The toxicities of urinary system,gastrointestinal tract and sexual function should be examined by further randomized control studies.A long-term observation is needed for the PSA-free survival rate.

Objective To explore the major correlation factors and cardiac pathological changes of sudden cardiac death (SCD).Methods The clinical and pathological profiles of 119 SCD cases at Wuxi People's Hospital Affiliated to Nanjing Medical University from January 1985 to March 2012 were retrospectively analyzed.And the parameters of gender,age,causes of death and pathological changes of SCD were included.Results Among them,the primary etiologies were coronary atherosclerotic heart disease (n =53,44.5％ ),hypertensive heart disease ( n =9,7.6％ ),myocarditis ( n =13,10.9％ ),acute pulmonary embolism ( n =8,6.7％ ) and myocardiosis (n =3,2.5％ ).The heart weights of male and female cases were (407 ± 126) and (349 ± 101 ) g respectively.Among 53 cases of coronary heart disease,there were 28 cases (52.8％ ) of grade Ⅳ coronary artery atherosclerotic stenosis and 17 were involved with multiple branches.The differences of coronary artery stenosis were insignificant between gender and age (P ＞0.05).Acute myocardial infarction occurred in 18 cases and 15 of them were complicated with old myocardial infarction (OMI) while there were 27 cases of simple OMI.Twenty cases ( 16.8％ ) without obvious cardiac organic pathological changes were classified as juvenile sudden unexplained death.Conclusions Sudden and dangerous SCD frequently occurs in elders.Multiple severe coronary atherosclerotic stenosis is an important pathological hallmark of SCD.

Objective To elucidate the relationship between the radiological features and prognoses of pneumocystis pneumonia ( PCP ) in non-acquired immunodeficiency syndrome ( non-AIDS )immunocompromised patients.Methods Retrospective analyses were performed for the radiological features and prognoses of 36 non-AIDS immunocompromised PCP patients hospitalized at Peking University First Hospital from April 2006 to April 2010.There were 24 males and 12 females with an average age of (51.7 ±18.9) years.Results All patients underwent chest photographic examinations and chest computed tomography (CT) was performed on 29 of them.The overall case fatality rate (CFR) of 36 patients was 33.3 ％ (12/36).At the start of anti-PCP treatment,there were normal chest radiography ( n =7),bilateral diffuse infiltration ( n =21 ),bilateral diffuse consolidation ( n =8 ),aerothorax,mediastinal emphysema or pneumohypoderma ( n =6) and numbers of deceased patients ( n =0,8,5 and 5 respectively).The CFRs of the patients with normal chest radiography and aerothorax,mediastinal emphysema or pneumohypoderma were both statistically significant as compared with the overall rate ( P ＜ 0.05 ).At the start of anti-PCP treatment,there were bilateral diffuse ground glass opacities (GGO) (n =29 ),"mosaic sign" (n =19 ),air bronchogram (n =19),pulmonary consolidation ( n =17 ),bilateral pleural effusion ( n =7 ),thickened lobular septa (n =6),cystic lesions ( n =5 ),aerothorax,mediastinal emphysema or pneumohypoderma (n =4) and numbers of deceased patients (n =8,5,5,5,2,2,2 and 4 respectively).The CFRs of the patients with aerothorax, mediastinal emphysema or pneumohypoderma were statistically significant as compared with the overall rate (P ＜ 0.05).Conclusions The major radiological features of PCP in nonAIDS immunocompromised patients are bilateral diffuse infiltration.And bilateral diffuse GGO on chest CT scans are usually accompanied with " mosaic" sign,air bronchogram or pulmonary consolidation.The prognoses are excellent for the patients with normal chest radiograph and poor for those with aerothorax,mediastinal emphysema or pneumohypoderma.

Objective To explore the incidence of perineural invasion (PNI) in hilar cholangiocarcinoma (HCCA) and summarize the distribution pattern of nerve plexuses around porta hepatis.Methods Reported series on PNI in HCCA were systematically reviewed.A clinicopathological study was conducted on sections from 75 HCCA patients to summarize the incidence and modes of PNI.Immunohistochemical stains for CD34 and D2-40 in tumor tissue were performed to clarify the association of PNI with microvessel and lymphoduct.Sections of different decks of hepatoduodenal ligament from 5 autopsy cases were scanned and computerized to display the distribution of nerve plexuses around porta hepatis.Results The incidence of PNI in HCCA in literature ranged from 59.2％ to 100％.In the present study,the overall incidence of PNI was 92.0％ (69/75).However,the incidence of PNI showed no remarkable differences among various differentiated groups and Bismuth-Corlette classification groups.Tumor cells could invade microvessels and lymphoducts in HCCA.But no invasion of nerves occurred via microvessels or lymphoducts as demonstrated by immunohistochemistry. Three nerve plexuses in hepatoduodenal ligament and Glisson's sheath were classified and they all surrounded great vessels very closely.Conclusion PNI is generally underreported in HCCA.A surgeon should handle diligently the nerve plexuses around porta hepatis.

Objective To evaluate the impact of surgical modality for gastric cancer on operational trauma.Methods A total of 1499 cases of gastric cancer undergoing surgical procedures were divided into the groups of radical resection (RR,n =1344) and palliative resection group( NRR,n =155 ) according to their surgical modalities.And they were further divided into sub-groups according to the profiles of gastrectomy,extent of lymphadenectomy and multiorganic resection.The extent of operational trauma ( as evaluated by operative duration, transfusion volume, postoperative hospital day and incidence of complications) was compared in different groups and subgroups.Results In RR and NRR groups,median transfusion volume ( Q1,Q3 ) was 0 ( 0,600 ) vs 400 ( 0,800) ml respectively.There was significant difference ( P ＜ 0.05 ).No significant difference existed in operative duration,postoperative hospital day or incidence of complications between two groups ( all P ＞ 0.05 ).In cases of distal gastrectomy,median transfusion volume was 0(0,400) vs 400(200,800) ml in RR and NRR groups (P ＜0.05).No significant difference existed in operative duration,postoperative hospital day or incidence of complications between two groups ( all P ＞ 0.05 ).In cases of total gastrectomy,no significant difference existed in operative duration,postoperative hospital day,median transfusion volume or incidence of complications between two groups ( all P ＞0.05).In RR group,for the cases treated by D1,D2,D3 and paraaortic lymph node dissection ( PAND),there were significant differences in operative duration ( (248 ± 71 ),( 271 ± 72 ),(309 ±96),(351±103) min),postoperative hospital day((13±4),(16±12),(18±11),(20±19) days),median transfusion volume(0(0,500),0(0,600),400(0,800),600(200,1000) ml)( all P ＜ 0.05 ).But no significant difference existed in incidence of complications ( P ＞ 0.05 ).In RR group,operative duration,postoperative hospital day,median transfusion volume was ( 315 ± 96) vs (264 ±66) min,(19 ±15) vs (15 ± 11) days,400(0,800) vs 0(0,400) ml in the patients with and without combined organic resection (all P ＜ 0.05 ).But no significant difference existed in incidence of complications ( P ＞ 0.05 ).Conclusions As compared with palliative resection,radical resection will not increase surgical trauma.For the cases of radical resection,extent of lymphadenecotmy and organic resection increase surgical trauma.

Objective To observe the relationship between erythropoietin receptor (EPOR) and autoantibodies-IgG/IgM (auto-Ab) on the membrane of erythropoietic cells of the patients with bone marrow mononuclear cells (BMMNC)-Coomb's test ( + ) hemocytopenia (immunorelated pancytopenia (IRP)) and explore the probable autoantigens of auto-Ab in IRP.Methods A total of 46 newly diagnosed IRP patients (15 with auto-Ab on erythropoietic cells and 31 without) and 18 healthy controls were enrolled.The EPOR expressions on their nuclear erythrocytes were tested with flow cytometry (FCM) to observe the relationship between EPOR and auto-Ab.EPOR mRNA was detected by reverse transcription (RT)-PCR.Stat5 and PStat5 proteins in nucleated erythrocytes were measured by Western blot.EPOR expressions on nucleated erythrocytes membrane were re-tested after stripping autoantibodies with glycine buffer.Results (1) EPOR of auto-Ab( + ) group( 1.6％ ± 0.9％ ) was significantly lower than that of auto-Ab (-) group(4.6％ ±4.1％,P ＜ 0.01 ) and the latter was significantly higher than that of normal controls ( 2.3 ％ ± 1.8％,P ＜0.05 ).EPOR of IRP patients was inversely correlated with their auto-Ab ( r =-0.543,P =0.000).( 2 )EPOR mRNA of auto-Ab( + ) group(0.68 ±0.14)was significantly higher than that of auto-Ab (-) group (0.55 ±0.12,P＜0.01)and normal controls(0.58 ±0.12,P ＜0.05).(3) Protein Stat5 of auto-Ab( + )group ( 1.45 ± 0.94 ) was significantly higher than that of normal controls ( 0.54 ± 0.36,P ＜ 0.05 ).While PStat5 of auto-Ab( + ) group(0.42 ±0.18)was significantly lower than that of normal controls(0.85 ±0.38,P ＜ 0.05 ).(4) EPOR expression increased significantly after auto-Ab stripping.Conclusions The auto-Ab of some IRP patients blocks or competitively inhibits EPOR on the membrane of erythropoietic cells.And EPOR may be one of autoantigens in IRP.

Objective To explore the effects of sildenafil on bladder compliance and endothelin-1 in the rabbit model of partial bladder outlet obstruction.Methods A total of 24 adult male New Zealand white rabbits were randomly divided into group A,group B,group C and group D (n =6 each).The rabbit model of partial bladder outlet obstruction was established in groups C and D while groups A and B underwent a sham operation.Daily sildenafil ( 10 mg/kg) was dosed to groups B and C by lavage.Daily normal saline was dosed similarly to groups A and D.Bladder urodynamic examinations were conducted in each group at Week 16.Then bladder was isolated and weighed from each group.And ET-1 in bladder tissue was measured by ELISA.Results Pressure thresholds for voiding (PT) in A-D groups were ( 10.6 ±2.0),(11.6 ±2.7),(14.0 ±4.2) and (20.4 ±6.1) cm H2O respectively.Compared with groups A,B and C,PT in group D was significantly higher ( all P ＜ 0.01 ).Bladder compliance in 4 groups were (2.75 ±0.51 ),(2.78 ± 0.46 ),( 4.98 ± 2.15 ) and ( 1.22 ± 0.25 ) ml/cm H2O respectively.Compared with groups A,B and C,bladder compliance was significantly lower in group D ( all P ＜ 0.01 ).Bladder compliance in group C was higher than that in groups A and B ( both P ＜ 0.01 ).The weights of bladder specimens in 4 groups were (5.0 ± 0.4),(4.6 ± 0.4),(8.2 ± 1.3 ) and ( 17.9 ± 2.3 ) g respectively.Compared with groups A and B,the weights of groups C and D were significantly heavier (all P ＜0.01 ).And the weight of group D was much greater than that of group C ( P ＜ 0.01 ).The contents of ET-1 in bladder tissue of 4 groups were (72 ± 19),(69 ± 18),(76 ± 21 ) and ( 106 ± 29) pg/g respectively.Compared with groups A,B and C,ET-1 in bladder tissue was significantly higher in group D (all P ＜0.05).Conclusions Daily sildenafil can effectively alleviate the damage of rabbit bladder compliance from partial bladder outlet obstruction and protect bladder functions.Its mechanism may be related with the downregulation of ET-1 in bladder tissue of partial bladder outlet obstruction.

Objective To explore the expression of CXC chemokine 5 (CXCL5) in liver cancer cells and its effect on cell proliferation,migration and invasion.Methods Real-time (RT)-PCR and enzyme-linked immunosorbent assay (ELISA) were used to detect the mRNA and protein levels of CXCL5 in 4 liver cancer cell lines with different metastatic potentials (in ascending order:HepG2,SMMC7721,MHCC97L and MHCC97H).HepG2 with a low expression of CXCL5 was treated with CXCLS.There were four groups:0 nmol/L CXCLS,0.1 nmol/L CXCLS,1.0 nmol/L CXCL5 and 10.0 nmol/L CXCLS.Cell proliferation was evaluated by cell counting kit-8 (CCK-8) assay.Transwell chambers and basement membrane matrix (Matrigel) were used to observe the cellular migration and invasion.Statistical analysis was performed with SPSS 16.0.Statistical comparison of the results was made by analysis of variance (ANOVA).Results The relative mRNA expression levels of CXCL5 in HepG2,SMMC7721,MHCC97L and MHCC97H were 0.002％ ±0.000％,0.005％ ±0.000％,1.030％ ±0.070％ and 0.980％ ±0.190％ (F =33.88,P ＜0.01)while their protein levels 14.3 ±0.4,25.7 ± 1.4,82.8 ±3.2 and 98.9 ±1.7 respectively (F =447.08,P ＜0.01 ).The CCK-8 results showed that cell proliferation increased with the treatment of CXCLS,but no significant difference existed ( F ＜ 1.00,P ＞ 0.05 ),cell numbers of migration of 0,0.1,1.0,10.0 nmol/L CXCL5 groups were 29 ± 3,56 ± 16,113 ± 7 and 130 ± 15 ( F =51.94,P ＜ 0.01 ),while cell numbers of invasion 17.3 ± 1.8,33.0 ± 3.2,65.7 ± 4.4 and 94.3 ± 3.5respectively ( F =104.13,P ＜ 0.01 ).Conclusions Liver cancer cells with high metastatic potential have a higher expression of CXCL5.And exogenous CXCL5 can increase the proliferation,migration and invasion of liver cancer cells with low metastatic potential.Thus CXCL5 may be associated with the metastasis of liver cancer.

A 49-year-old male was admitted to the hospital on December 3, 2010 due to paroxysmal abdominal pain after eating for 2 years. Two years ago, the patient developed paroxysmal abdominal pain, all occurred about 30 minutes after satiating, occasionally accompanied by lightning-like headache, cold sweat, and intermittent small amount of hematuria. Gastroduodenal ulcer was considered by gastroscopy in a local hospital, and the symptoms were not relieved after oral medication for 2 years. On November 18, 2010, the somatostatin receptor imaging in our hospital showed multiple somatostatin receptor high-expression nodules at the level of the anterior pararenal hilum of the retroperitoneal spine, considering the possible source of neuroendocrine tumor; Three-dimensional CT reconstruction of abdomen and pelvis: multiple retroperitoneal soft tissue density occupying lesions, multiple paragangliomas possible; PET-CT: Multiple retroperitoneal metabolic hypertension foci, standard uptake value (SUV) 6.9, which were space occupying and lymph nodes (Figure 1A), and malignancy was not excluded. Further admission was made with "retroperitoneal space occupying, neuroendocrine tumor is likely".

irritable bowel syndrome (IBS) is the most common functional gastrointestinal disease [1]. Patients suffer from abdominal pain or abdominal discomfort related to defecation for a long time, and are often accompanied by emotional disorders such as anxiety and depression [2]. In recent years, researchers at home and abroad have applied functional brain imaging technology to confirm that local cerebral cortex activation can occur in IBS patients under rectal dilation stimulation, among which the anterior cingulate gyrus (ACC) and insular lobe (IC) are the most reported [3-6]. ACC and IC participate in the central regulation of visceral pain sensation and emotional arousal mechanism [7-8]. Then, what kind of relationship exists between the excitability of ACC and IC and abdominal pain and emotional disorders in IBS patients? The results of recent IBS functional brain imaging studies are summarized as follows.

Mitochondrial encephalomyopathy with hyperlactatemia and stroke-like attack (MELAS) syndrome is a clinical heterologous multisystem disease caused by abnormal mitochondrial structure or function, which causes disorders of respiratory chain and even the whole energy metabolism process, with the most serious involvement of brain tissue and muscle. The disease is inherited from maternal lineage, also sporadic, with complex and variable clinical manifestations and high misdiagnosis rate.

In recent years, the incidence of breast cancer has been increasing obviously, and it has become the malignant tumor with the highest incidence rate in women in China.Endocrine therapy (ET) has remarkable therapeutic effect on estrogen and progesterone receptor positive breast cancer patients, and the adverse reactions are minor.However, the main clinical problem faced by ET is the occurrence of drug resistance.To solve this problem at the molecular level, it is an inevitable trend to carry out molecular targeted endocrine therapy [1], seek the detection factors to evaluate ET drug resistance and explore new targets of targeted combination therapy.

The adenomatoid tumor occurring in the parenchyma of the testis is very rare. We diagnosed and treated one case, and the report is as follows. The patient, male, 46 years old, complained of "inadvertently discovering a mass in the left testis for 2 weeks". During physical examination, the patient palpated the mass in the left testis, about 1.0cm ×1.0cm in diameter, with hard texture, no tenderness and clear boundary. Laboratory examination: serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (β-HCG) were within the normal range. Ultrasound examination: the mass in the left testis was heterogeneous, surrounded by abnormal echoes of rhythm, and the internal blood flow signal was not abundant; CT plain scan + enhancement: localized mass in left testis, 1.0cm ×0.7cm, CT value 46 Hz, no obvious enhancement.