Volume 91  ·   Issue 38  ·  2011

Autopsy (abbreviated as autopsy) is of great significance to clarify the cause of death, verify the accuracy of clinical diagnosis and evaluate whether the implementation of treatment plan is appropriate, and then improve the level of clinical diagnosis and treatment, which is of great significance to promote the progress of medical science [1]. Although the "hospital grading standard" issued by the Ministry of Health stipulates that the autopsy rate should reach 15% in Class III A hospitals and 10% in Class II hospitals [2], in fact, due to the restriction of traditional concepts and insufficient publicity of autopsy work, all kinds of hospitals in China are facing the present situation of low autopsy rate, and this index is showing a sharp decline trend.

The English abbreviation of renal artery stenosis in heart failure (RASHEF) in ancient Mesopotamia means "God of Plague". Although the text coincidence has no special meaning, research shows that suffering from renal artery stenosis will increase the risk of death and may make the prognosis of patients with heart failure worse, and it is the "God of Plague" of patients with heart failure.

Atrial fibrillation (AF) is the most common persistent arrhythmia that seriously endangers people's health, and increases the risk of stroke and mortality. Because of the high prevalence of AF, serious harm and lack of ideal treatment, clinical research of AF has been a hot spot in the field of electrophysiology. This article will introduce the clinical research and treatment status and progress of drug therapy (ventricular rate control and rhythm control), antithrombotic therapy and non-drug therapy in recent years.

Objective To compare the plasma concentrations of N-terminal brain natriuretic peptide precursor (NT-proBNP) in patients with heart failure due to various heart diseases and analyze the influencing factors.Methods We enrolled a total of 804 heart failure patients due to various heart diseases,including valvular heart disease (VHD),dilated cardiomyopathy (DCM),ischemic heart diseases (IHD),restrictive cardiomyopathy ( RCM ),hypertensive heart disease ( HHD ),hypertrophic cardiomyopathy (HCM),pulmonary heart disease (PHD) and adult congenital heart disease (CHD).The plasma concentration of NT-proBNP was measured by enzyme-linked immunosorbent assay (ELISA).Multiple linear regression analysis was used to detect the influencing factors for the plasma concentration of NT-proBNP.Results The plasma concentration of NT-proBNP had no significant difference between patients with VHD,DCM,IHD,RCM,HCM,PHD,HHD and CHD.The median (25 percent,75 percent) values were 1866(803 -3973),2247( 1087 - 3865),2400( 1182 -4242),2456( 1385 - 5839),2204( 1053 - 3186),2285 ( 1155 - 3424 ),2313 ( 655 - 3850 ) and 2768 ( 795 - 4371 ) pmol/L respectively ( P ＞ 0.05 ).It increased with New York Heart Association (NYHA) class from Ⅱ through Ⅲ to Ⅳ.The median ( 25percent,75 percent) values were 646 (447 - 1015 ),2160 ( 1118 - 3750) and 3342 ( 1549 - 5455 ) pmol/L respectively (P ＜0.01 ).The patients with a body mass index (BMI) of ≥25 kg/cm2 had a lower NTproBNP concentration than those with a BMI of ＜25 kg/cm2.The median (25 percent,75 percent) values were 1468 ( 784 - 3177) and 2424 ( 1090 -4213 ) pmol/L respectively ( P ＜ 0.0l ).Patients with a serum creatinine concentration of ≥ 107 μ mol/L had a higher NT-proBNP concentration than those ＜ 107 μmol/L.The median (25 percent,75 percent) values were 3337 ( 1470 - 5380) and 1644 (781 - 3375 ) pmol/L respectively (P ＜ 0.01 ).Multiple linear regression analysis demonstrated that NYHA class,creatinine,BMI,hepatic damage and diastolic pressure were independently associated with the plasma concentration of NT-proBNP ( all P ＜ 0.01 ).Conclusion The plasma concentration of NT-proBNP has no significant difference between heart failure patients due to various heart diseases.Its level may be affected by NYHA class,serum creatinine,BMI,hepatic damage and diastolic pressure.

Objective To explore the effects of aerobic exercise on exercise tolerance in patients with chronic heart failure (CHF).Methods A total of 50 CHF patients with left ventricular ejection fraction (LVEF) ＜ 49％ by echocardiography were enrolled.And they were randomly divided into exercise group ( n =25) and non-exercise group (n =25).Cardiopulmonary exercise testing (CPET) was performed.The patients of exercise group underwent an aerobic exercise program in which exercise intensity was decided by anaerobic threshold (AT) before 10 J/s while those of non-exercise group performed daily activities.After 6 sessions of supervised aerobic exercise,the home-based aerobic exercise training began.CPET was reexamined 3 months later.Results The VO2 AT,VO2 peak,Load AT,Load peak,peak VO2/HR and VE/VCO2 slope at baseline were similar between exercise group and non-exercise group ( P ＞ 0.05 ).The VO2 AT,VO2 peak,Load AT,Load peak and peak VO2/HR in patients of exercise group were increased compared with baseline,The differences between baseline and 3 months later expressed as ΔVO2 AT,ΔVO2 peak,ΔLoad AT,ΔLoad peak,Δpeak VO2/HR and ΔVE/VCO2 slope,The differences of ΔVO2 AT,ΔVO2 peak,ΔLoad AT,ΔLoad peak and Δpeak VO2/HR between two groups were statistically significant [ΔVO2 AT:2.8(1.2-3.5)ml · kg-1 · min-1 vs -0.3( -2.8-0.1)ml · kg-1 · min-1,P ＜0.01;ΔVO2 peak:3.4(1.8-4.6)ml · kg-1 · min-1 vs -0.5(-1.4-0.3) ml · kg-1 · min-1,P＜0.01;ΔLoad AT:15.0(2.5 -22.5) J/s vs 0.5( -4.2 -3.8) J/s,P ＜0.01 ; ΔLoad peak:15.0( 1.3 -25.0)J/s vs0.0 ( -8.8 -15.0) J/s,P＜0.05; Δpeak VO2/HR:2.3(0.0-4.0)ml · kg-1 · beat-1 vs -0.1( -0.7- 1.2) ml · kg-1 · beat-1,P ＜0.01].The difference of ΔVE/VCO2 slope was not statistically significant [-2.3( -12.2-1.8)vs 1.0( -0.4 - 2.6),P ＞ 0.05].Conclusion After 3 months of aerobic exercise,exercise capacity may improve in the CHF patients.

Objective To evaluate systemically the prevalence and prognostic values of liver function abnormalities in patients with chronic systolic heart failure (HF) have not been systematically evaluated.Methods A total of 16 681 hospitalized patients with a diagnosis of chronic systolic HF and left ventricular ejection fraction (LVEF) ＜50％ were recruited from 12 hospitals in Hubei Province.All patients were followed up by telephone contacts.And they were divided into the death and survival groups according to the follow-up results.Results Over a median follow-up period of 3 years,6453 (38.69％) patients died.The prevalence of liver function abnormality was 71.94％ ( 12 001/16 681 ).The elevations of direct bilirubin,γ-glutamyl-transferase and alanine aminotransferase were the most common findings accounting for 33.37 ％ (4863/14 574),32.51％(4337/13 341)and 30.12％ (5024/16 681) respectively.The abnormality of alkaline phosphatase was rare and its increase and decrease accounted for 3.82％ (474/12 397) and 4.51％(559/12 397 ) respectively.The prevalence of low albumin and total bilirubin elevation was 23.24％(3408/14 664) and 19.37％ (3231/16 681 ).And high direct bilirubin (HR 1.264,95％ CI 1.103 -1.423 ; P =0.02 ),high total bilirubin ( HR 1.126,95％ CI 1.019 - 1.234 ; P =0.02 ) and low albumin( HR 0.889,95％ CI 0.794 -0.889; P ＜ 0.01)were determined as the independent risk factors of total mortality.There were the correlations of LVEF with direct bilirubin ( r =- 0.235,P ＜ 0.01 ),total bilirubin (r =-0.209,P ＜ 0.01 ),albumin ( r =0.107,P ＜ 0.01 ) and right ventricular end-diastolic diameter (RVDD) with direct bilirubin( r =0.149,P ＜ 0.01 ),total bilirubin ( r =0.154,P ＜ 0.01 ) and albumin ( r =- 0.086,P ＜ 0.01 ).Conclusion The prevalence of liver function abnormalities is high in patients with chronic systolic HF.Low albumin,high direct bilirubin and high total bilirubin increase their total mortalities.Low LVEF and high RVDD are positively correlated with a high prevalence of liver function abnormalities.

Objective To explore the therapeutic feasibility of percutaneous puncture and neurolytic thoracic sympathetic nerve block under the guidance of computed tomograph (CT).Methods From September 2009 to August 2010,23 cases with primary palmar hyperhidrosis underwent percutaneous puncture and neurolytic thoracic sympathetic nerve block at our hospital.The puncture of thoracic sympathetic nerve was guided by CT through the gap of T3-4.The screen showed the direction of needle and the location of needle tip at the upper joint of costal head beside T3 body and outside of costal pleura.A mixed injection of 1％ lidocaine and 30％ iohexol was administered.On CT,lidocaine was found to cover the area where the thoracic sympathetic nerve was located.And after several minutes,the patient's palms turned warm and dry from cool and wet without the onset of Homer's syndrome.Then 2.5 ml of absolute alcohol was injected to block the thoracic sympathetic nerve.Results CT could guide the needle to the right position.And the injectate spreaded to the site of thoracic sympathetic nerve.At 5 min after anesthetic injection,the palmar temperature raised an average of 2.86 ℃ and the amplitude of pulse rose over 55％.Palmar hyperhidrosis was cured in 19 patients by one attempt and 4 patients required a second block with absolute alcohol.No complication occurred and there were 2 patients with tendency of recurrence during a follow-up period of 8 - 18 months.Conclusion The CT-guided therapy of percutaneous puncture and chemical neurolysis of thoracic sympathetic nerve block is both feasible and efficacious for palmar hyperhidrosis.

Objective To survey the incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in males aged ≥ 50 years and explore the correlation between LUTS and ED.Methods A cross-sectional study was performed at Beijing communities in 1644 males aged over 50 years.The International Index of Erectile Function-5 (IIEF-5) and International Prostate Symptom Score (IPSS) were recorded.Pearson's x2 test and Spearman correlation coefficients were used to analyze the results of IPSS,LUTS and their correlations with ED.Results The mean age was 64.5 years old (range:50 -93),the mean value of IPSS(9.9 ±8.2),the prevalence of mild,moderate and severe LUTS 49.2％(809/1644),36.4％ (599/1644) and 14.4％ (236/1644) respectively.The mean value of IIEF was (9.4 ±8.6),the total incidence of ED 90.5％ (1487/1644) and the incidence of ED of mild,moderate and severe LUTS 85.7％ (694/809),93.7％ (561/599) and 97.9％ (231/236) respectively.The total IIEF-5 score was found significantly correlated with the total IPSS score ( r =- 0.335,P ＜ 0.01 ),the obstructive symptoms( r =- 0.276,P ＜ 0.01 ) and irritative symptoms ( r =- 0.326,P ＜ 0.01 ).The severity of LUTS was correlated with the severity of ED ( r =0.304,P ＜ 0.01 ).Correlations also existed between age and total IPSS score(r =0.388,P ＜ 0.01 ),LUTS severity ( r =0.457,P ＜ 0.01 ),total IIEF score( r =-0.533,P ＜ 0.01 ) or ED severity( r =0.529,P ＜ 0.01 ).Conclusion The incidence of LUTS or ED in aging males increases with age.The severity of ED is positively correlated with the severity of LUTS.Irritative and obstructive symptoms influence the occurrence of ED in aging males.

Objective To summarize the vascular surgical strategies for chest and abdomen tumors with the invasion of great vessels.Methods The clinical data were collected for 67 patients undergoing surgical treatment for tumors with the invasion of thoracic and abdominal great vessels at our hospital from January 2001 to June 2009.Then a retrospective analysis was performed.Among this dataset,there were 31 cases with only vessel wall invasion and 20 cases with only intravascular tumor thrombus.In the meanwhile,both the invasion of vascular walls and the formation of tumor thrombus were located in 16 patients.Results Among 67 operated patients,various strategies were used,including surgical adhesion lysis ( n =15 ),vascular resection direct suture (n =24),artificial blood vessel patch (n =10),pericardial patch (n =3),artificial vascular replacement or bypass (n =15 ) and cavity thrombectomy ( n =36).Cavity thrombectomy was performed under cardiopulmonary bypass for 8 patents with tumor invasion of right atrium.Among them,58 patients received radical tumor resection while palliative resection was performed for 9 patients with a rateof complete resection at 86.6％.There was no intraoperative mortality with the perioperative death of 8 cases.A follow-up study was successfully conducted for 52 patients.And 7 patients were lost to follow-up.The overall follow-up rate was 88.1％.By June 2009,the survival period of this group of patients was as follows:18 cases ( ＞48 months),29 cases ( ＞24 months),38 cases ( ＞ 12 months),50 cases ( ＞6 months) and 2 cases (≤6 months).Among these patients,the major cause of mortality was tumor metastasis.The patients with kidney cancer showed the most favorable surgical outcomes.Conclusion Managed by a variety of vascular surgical techniques,the patients with tumors involving major blood vessels may achieve an excellent success rate of tumor resection and a better postoperative quality-of-life.

Objective To explore the feasibility of multi-slice spiral computed tomography ( CT )with a lower dose as one-off examination for the preoperative morphology evaluation and the quantification of unilateral renal glomerular filtration rate of living renal donors.Methods A total of 36 living renal donors at our hospital from May 2008 to June 2009 were examined by 64-slice spiral CT and single photon emission computed tomography (SPECT).Living renal donors were examined with a plain scan and three-phase enhancement CT scan.Also there were two inserted dynamic scans,one after the injection of contrast agent and the other between cortex and parenchymal phases.Image reconstructions were performed to observe renal parenchyma,renal vessels and collecting system.Comparisons were made with intra-operative findings.And the known Patlak equation was used simultaneously.The glomerular filtration rate (GFR) in a single kidney was calculated on CT and SPECT respectively.The GFRs of two groups were analyzed to investigate the Pearson correlation and simple linear regression between them.Results Twenty of 36 renal living donor kidneys underwent the operation,variations of morphology detected by CT were all corresponded with the operation.The GFR values estimated from CT were (42.4 ±8.9) ml/min (left) and 43.2 ± 8.4) ml/min (right).While GFR of SPECT 47.4 ± 9.3) ml/min (left) and 48.2 ± 8.5) ml/min (fight).Linear trend was found between the GFRs of CT and SPECT.Pearson's product-moment correlation coefficient r =0.753(left) (P ＜ 0.01 ),r =0.709 (right) (P ＜ 0.01 ).These values indicated that the GFR from CT was positively correlated with the GFR from SPECT.Conclusion During the preoperative evaluation,multi-slice spiral CT may provide both anatomic information and the GFR of living renal donors.

Objective To explore the relationship between minimal residual disease (MRD) and the outcome of patients with high-risk acute leukemia (AL) undergoing allogeneic hematopoietic stem cell transplantation (HSCT).Methods By 4/5-color multi-parameter flow cytometry (MFC,CD45/SSC gating) for detecting MRD at pre- (day-30) and post-transplant( day + 30,+ 60,+ 100,6 months,9 months and 12 months),the investigators retrospectively analyzed the MRD levels and the prognosis of 90high-risk patients.According to the MRD cutoff value of 0.1％,the low-level and high-level groups were defined.In the high-level group,the patients were divided into two sub groups according to the subsequent treatment ( intervention therapy group and non-intervention therapy group).Results MRD pre-transplant had no predictive value for the clinical outcome.The patients with high levels of MRD post-transplant ( + 60 d and + 100 d) showed higher relapse rates than those of the low-level group.In addition,regarding MRD +100 d post-transplant,differences were significant among 3 groups (high-level MRD and intervention theray group,high-level MRD and non-intervention therapy group and low-level MRD group)including 1-year relapse-free survival (RFS) ( 100％ vs 60.87％ vs 91.30％,P ＜ 0.05 ) and 3-year RFS (85.71％ vs 44.72％ vs 68.48％,P ＜0.05).The median time from first high level MRD detected to clinical relapse was 2.5 (1 -26) months.In the high level MRD group ( + 100 d post-transplant),7 of 30 patients received intervention therapy without relapse.However another 23 patients had no intervention treatment and 11 of them relapsed latter (P ＜ 0.05 ).Conclusion The MFC-based quantification of MRD post-transplant reveals important prognostic information in patients with high-risk AL.MRD check point at day + 100 (cutoff:0.1％ ) may discriminate different risk populations.Those patients with MRD levels ≥0.1％ should receive early intervention at an early stage and a low tumor burden so as to reduce the relapse rate and boost survival.

Objective To explore the related factors of difficult-to-wean patients in medical intensive care unit (MICU).Methods A retrospective analysis was performed for 112 patients placed on mechanical ventilation.There were 63 males and 49 females with a mean age of (58 ± 26) years.Their primary diseases included acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (n =27 ),pneumonia ( n =20),asthma ( n =12) and neuromuscular diseases ( n =8 ).Basic admission profiles,underlying diseases,accompanying diseases and pre-weaning changes in physiological indicators were recorded.They were divided into 2 groups:successfully-weaned group and different-to-wean group.Logistic regression analysis was used to analyze the risk factors correlated with the difficult withdrawal of mechanical ventilation.Results There were 27 (24.1％ ) diffficult-to-wean patients on mechanical ventilation in MICU.Some underlying diseases had statistical significance in both groups,including AECOPD (x2 =6.238,P =0.028 ),idiopathic pulmonary fibrosis ( x2 =5.232,P =0.025 ) and neuromuscular disease ( x2 =14.635,P =0.007 ).The ratios of difficult-to-wean patients were 9/27,2/6 and 6/8 respectively.There was statistical significance of pre-admission and pre-weaning oxygenation index between two groups (t =2.183,2.162,P ＜ 0.05 ).Zubrod score at pre-weaning was also significantly different between two groups ( t =9.037,P ＜0.05).Logistic regression indicated that the patients with severe heart failure (OR =5.781 ),psychological disorders ( OR =4.654 ),obstructive sleep apnea ( OR =4.012 ),AECOPD ( OR =3.617 )and neuromuscular diseases ( OR =2.885) were more vulnerable to weaning difficulties.Conclusion The major risk factors of difficult-to-wean patients in MICU include severe heart failure,psychological diseases,obstructive sleep apnea,neuromuscular disease and AECOPD.And oxygenation and self-care capability may also affect weaning significantly.

Objective To explore the protective functions of recombinant protein RANK-Fc against hepatic ischemia/reperfusion injury and clarify its possible mechanism.Methods Sixty male Balb/c mice were randomly divided into 3 groups according to different treatments:serum-free medium control ( Sham )group,target gene retrovirus (RANK-Fc)group and empty vector retrovirus (eGFP)group.All mice were injected with 2.5 ml solution( with or without retrovirus)within 6 seconds via tail vein.After 3 days,the model of 70％ hepatic ischemia/reperfusion was induced under warm conditions for 90 minutes after different periods of reperfusion in RANK-Fc and eGFP groups; Sham group underwent the same procedure without the occlusion of blood supply.Blood and liver samples were obtained at different time points ( 1,3,6 and 24 h;n =5 in each).Reverse transcription-polymerase chain reaction (RT-PCR) was used for the evaluation of eGFP mRNA expression.RANK-Fc was assessed by Western blot.Liver transaminases and histopathological changes were used for the evaluation of hepatic injury.The activity of NF-κB in liver nucleus was analyzed by Western blot and immunohistochemistry.The activation level of JNK was also assessed by Western blot.Liver homogenate levels of tumor necrosis factor (TNF)-α and interleukin ( IL)-6 were detected by enzymelinked immunosorbent assay (ELISA).Apoptosis was identified by the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) analysis.The differences between three treatment groups at each time point were detected by the one-way ANOVA.Statistical analysis for inter-comparison was performed by Student's t test.Results RANK-Fc and eGFP were successfully expressed in liver after hydrodynamicsbased transfection.Compared with eGFP group,RANK-Fc significantly improved liver functions at the same time point ( P ＜ 0.01 ),decreased NF-κB nuclear translocation ( t =6.726,P ＜ 0.01 ) and JNK phosphorylation(t =6.713,P ＜ 0.01 ) and obviously suppressed the release of pro-inflammatory cytokine TNF-α (t =4.779,P ＜ 0.0l ) and IL-6 ( t =5.482,P ＜ 0.01 ).Morphological injuries were markedly alleviated while the expressions of immunohistochemical positive ceils and TUNEL staining positive cells decreased in RANF-Fc group.Conclusion RANK-Fc has protective functions against hepatic ischemia/reperfusion injury in mice.Its mechanism is at least partially related with the suppressions of proinflammatory NF-κB and proapoptotic JNK signaling pathways.

Objective To isolate the transforming growth factor-beta 1 (TGF-β1) phage model peptides from phage 12-mer display peptide library to inhibit the proliferation of keloid fibroblasts.Methods The phage display 12-mer peptide library was screened for 4 rounds with monoclonal anti-human TGF-β1 as the target to yield the specific phage model peptides.The 3-( 4,5-dimethyhhiazol-2-yl )-2,5-diphenyltetrazolium bromide (MTT) assay was used for the quantitative determination of cellular proliferation.Apoptosis was detected by the Annexin V-FITC/PI apoptosis detection kit and the cells were analyzed with flow cytometry.lmmunofluorescent assay was employed to show the binding affinity of model peptides for keloid fibroblasts.Quantitative real-time polymerase chain reaction (PCR) was performed to detect the expressions of nuclear factor kappa B (NF-κB) and connective tissue growth factor (CTGF).Results Ten phage model peptides were obtained and they were similar to TGF-β1,TGF-β2,TGF-βreceptor Ⅱ (TβRⅡ),TGF-β-induced factor,NF-κB or mitogen-activated protein kinase (MAPK).The results of MTT showed that four phage model peptides ( No.7 - 10) could inhibit the proliferation of keloid fibroblasts ( P ＜ 0.05 ).The results of apoptotic assessment showed that phage model peptides ( No.7 - 10)could slightly trigger the late apoptotic stage of keloid fibroblasts.The data of immunofluorescence assay revealed that the model peptides on phages rather than phages could bind to keloid fibroblasts.The findings of quantitative real-time PCR analysis suggested that the relative expression of NF-κB decreased in phage model peptides groups (No.7 -10).The quantitative expression was 0.28,0.26,0.46 and 0.30respectively versus the negative control group.The relative expression of CTGF decreased in phage model peptides groups (No.7- 10).The quantitative expression was 0.26,0.60,0.34 and 0.17 respectively versus the negative control group.Conclusion Four phage model peptides ( No.7 - 10) isolated from phage display 12-mer peptide library can inhibit the proliferation of keloid fibroblasts via regulating the expressions of NF-κB and CTGF.

Researchers at the University of Texas Southwestern Medical Center recently discovered potential drug targets for advanced prostate cancer by demonstrating that advanced tumors are driven by a hormone pathway different from previously recognized.

Previous studies have shown that eosinophil-mediated inflammation is a hallmark factor in airway remodeling, while recent studies by Grainge et al. evaluated the effect of airway constriction induced by repeated inhalation of allergens on airway structural changes in asthmatic patients (N Engl J Med, 2011, 364: 2006-2015), showing that the strong mechanical dynamics generated during bronchoconstriction may also be a factor independent of inflammation to induce airway remodeling.

A 29-year-old male was admitted to the respiratory department of our hospital in February 2009 due to cough for more than 1 year, aggravated with fever for 5 months. The patient developed cough without obvious trigger 1 year ago, coughed a little white phlegm, and had no fever; Five months ago, the cough and expectoration worsened, with a little bloody sputum, high fever, accompanied by fatigue, night sweats and weight loss. CT examination in the local hospital showed mild infection in the middle and lower lobes of the right lung, and small nodules in the right upper lung. The tuberculin test result was 12 mm ×12 mm, and the diagnosis was "tuberculosis". The body temperature did not drop significantly after 25 days of quadruple anti-tuberculosis treatment with isoniazid, rifampicin, pyrazinamide and ethambutol, so he was transferred to our hospital for anti-infection treatment such as cefoperazone, sulbactam, azithromycin and levofloxacin, but the body temperature still repeated.

Ischemic heart disease has become the main cause of human death, especially after acute myocardial infarction in coronary artery disease, because a large number of terminal differentiated myocardial cells have limited regeneration ability after necrosis, which leads to serious decline of cardiac function, leading to left ventricular remodeling and enlargement, and finally leading to heart failure, and the prognosis is very poor.Although the existing coronary recanalization therapy (including emergency thrombolysis and intervention) can save part of ischemic myocardium, it cannot realize myocardial regeneration.In recent years, the method of stem cell transplantation has emerged for myocardial reconstruction, which has opened up a new way for the treatment of ischemic heart disease.Inducible pluripotent stem cells (iPSCs) have the characteristics of embryo-like stem cells and are autologous sources.As transplanted donor cells, they can differentiate into myocardial cells in vivo, which makes them become the research hotspot in the field of cardiovascular regeneration again, and show good clinical application prospect.

heart failure (HF) is a common clinical syndrome of many advanced cardiovascular diseases, which seriously endangers human health. In recent years, although great progress has been made in drug therapy and implantable mechanical device therapy, its incidence and fatality and disability rate are still high. Gene therapy, especially the treatment method targeting sarco/endoplasmic reticulum calcium ATPase 2a (SERCA2a), provides a new idea for the treatment of HF. In view of the remarkable effect achieved in animal experiments, this therapy has entered the stage of clinical research. This paper reviews the gene therapy of HF targeting SERCA2a, focusing on its mechanism of action and the progress of clinical research.

A 47-year-old male was seen in July 2010 due to intermittent full-course macroscopic hematuria for more than 6 months. The hematuria was accompanied by frequent urination, urgency and painful urination, and there was no other discomfort. Physical examination: light tapping pain in the left kidney area, and no abnormalities in other urinary tract examinations. Urinary routine showed "200 red blood cells/μ L and 55 white blood cells/μ L". The phase of urinary red blood cells showed that orthomorphic red blood cells were the main ones; No cancer cells were found in urine exfoliation cytology; Blood routine, liver and kidney function, erythrocyte sedimentation rate, tuberculosis antibody and prostate specific antigen were all normal. B-mode ultrasound and intravenous urography (IVU) all showed "moderate left nephrosis"; CT and MR showed "soft tissue shadow at the middle pole of the left kidney, about 8 mm ×6 mm, moderate hydronephrosis in the left kidney, no enlargement of renal hilar lymph nodes, and no tumor thrombus in the renal vein" (Figure 1); Renal radionuclide scan (ECT) showed normal perfusion of left kidney and mild impairment of function [GFR 35.4 ml/min], and normal perfusion and function of right kidney (GFR 50.9 ml/min). The patient had been seen in many county and city hospitals and was diagnosed with "renal granuloma" or "renal tuberculosis". After various antibiotics and anti-tuberculosis treatment, hematuria still recurred.

A 52-year-old male was admitted to the hospital on May 17, 2010 with the discovery of a tumor in the anterior cervical area for 2 days. He had no symptoms of hyperthyroidism such as palpitation, shortness of breath, excessive food, hunger, irritability, and irritability, and no breathing or dysphagia. Physical examination showed that a single nodule with a maximum diameter of about 4 cm could be palpable in the left lobe of thyroid gland, with a smooth surface, clear boundary, medium texture and no tenderness. It moved up and down with swallowing, and no swollen lymph nodes were palpable in the neck. Ultrasound examination showed that hypoechoic was found from the body to the lower pole of the left lobe of thyroid gland, about 42.9 mm ×33.0mm, with clear outline, rough and uneven echoes, locally lobulated and grid-shaped, and tiny dot-like hyperechoic was seen inside. There were no obvious swollen lymph nodes in both necks. Thyroid function was normal.

A 39-year-old female was admitted to the hospital on November 17, 2010 because a right adrenal mass was found in physical examination for more than 2 weeks. The patient had no symptoms such as palpitation, headache, dizziness and blurred vision. The physical examination was not special, and her blood pressure was 130/85 mm Hg (1 mm Hg =0.133 kPa). Laboratory examination showed that the electrolyte was normal, the level of catecholamines in urine was normal three times, and the level of adrenal cortex and medulla was normal. Ultrasound examination showed that the right adrenal gland occupied space, with a diameter of 3.8 cm ×4.5 cm, hypoechoic and abundant blood flow; Abdominal CT: Right adrenal upper pole mass, 3.5 cm ×4.5 cm in diameter, with intact capsule, smooth surface and uneven enhancement (Figure 1). The preoperative diagnosis was adrenal cortical adenoma, because the tumor could not be excluded from the adrenal medulla, and the drug was given for 2 weeks before operation. The surgical method was laparoscopic retroperitoneal right adrenal tumor resection.

A 60-year-old female was found to have medial left forearm ecchymosis 6 years ago. Blood routine in our hospital showed that platelets were 48.0×109/L. After examination, she was diagnosed as immune thrombocytopenic purpura (ITP). After treatment with oral prednisone acetate tablets (60 mg once a day), there was no improvement. After gradually reducing the dose within six months, she was treated with vincristine (2 mg intravenous drip, once a week, 4 times in total). The platelets increased, the highest was 60.0×109/L. After stopping the drug, the platelets gradually decreased to (20~30) ×109/L. After being diagnosed as refractory ITP, she was discharged from hospital. After that, the patient was not diagnosed and treated, and often had ecchymosis and petechiae on the skin of the whole body.