Volume 94  ·   Issue 22  ·  2014

Pulmonary hypertension is a hemodynamic abnormality with elevated pulmonary artery pressure, which often leads to increased right ventricular load and right ventricular dysfunction, thus causing a series of clinical manifestations. In the past, when pulmonary hypertension was mentioned, it was often thought that it was rare and had a very poor prognosis. In fact, this view was very one-sided. On the one hand, pulmonary hypertension can be derived from the lesions of the pulmonary blood vessels themselves, such as idiopathic pulmonary hypertension (IPAH), or secondary to other heart, lung or systemic diseases, which is not uncommon in clinic; On the other hand, great progress has been made in the treatment of pulmonary hypertension in recent years. With the standardization of diagnosis and treatment, the prognosis of patients with pulmonary hypertension has been greatly improved.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension characterized by intravascular thrombotic obstruction, luminal stenosis or occlusion. It belongs to the fourth category of pulmonary hypertension and is also a type of pulmonary hypertension that can be cured potentially. Organized thrombosis and pulmonary vascular remodeling are considered to be the main components of CTEPH. The interaction between them is not only the key link in the pathogenesis of CTEPH, but also closely related to the severity, treatment choice and prognosis of CTEPH^[1]。 Therefore, the interaction mechanism between thrombosis and pulmonary vascular remodeling, how to accurately diagnose and evaluate thrombosis and vascular remodeling, and explore the corresponding medical and surgical treatment methods have attracted much attention in the clinical research of CTEPH in recent years, which is briefly described below.

To explore the effects of estrogen (E2) on angiotensin converting enzyme-angiotensinⅡ-angiotensin type 1 receptor (ACE-AngⅡ-AT1) axis in hypoxic pulmonary hypertension rats.

A total of 60 healthy female Sprague-Dawdley (SD) rats were divided randomly into 6 groups (n=10 each) of sham operation, pure ovariectomy (OVX), pure hypoxia, OVX+ hypoxia, OVX+ E2 and OVX+ hypoxia+ E2. Abdominal cavity was opened for sham operation group and bilateral ovaries were left intact without any other procedure. The pure OVX group underwent oophorectomy. The pure hypoxia group were placed into a low-oxygen environment (24 hour, 8 weeks). The OVX+ hypoxia group were placed into a low-oxygen environment after bilateral oophorectomy. The OVX+ E2 group received a subcutaneous injection of E2 (20 μg·kg ^-1·d^-1) after bilateral oophorectomy. The OVX+ hypoxia+ E2 group had an injection of E2 and was placed into a low-oxygen environment after bilateral oophorectomy. The rats were feed continuously for 8 weeks to establish hypoxic pulmonary hypertension model. The mean pulmonary artery pressure (mPAP) was measured after bloodletting. Then right ventricle hypertrophy index (RVHI) and hematoxylin-eosin pulmonary artery remodeling (HPSR) were observed. And electron microscope was employed to observe pulmonary arteriolar ultrastructure. The methods of radio-immunity assay, ultraviolet spectroscopy, Western blot and reverse transcription PCR were used to measure the levels of CE, AngⅡand AT1 in sera, lung and pulmonary artery.

The vascular walls of pure hypoxia and OVX+ hypoxia groups became thickened and lumen narrowed. mPAP and RVHI were (32.4±2.2) mmHg (1 mmHg=0.133 kPa), 0.331±0.032 and (37.9±1.6) mmHg, 0.433±0.033. Both were significantly higher than those of Sham operation group ((12.6±1.8) mmHg, 0.233±0.029) (both P<0.05); the above parameters of OVX+ Hypoxia+ E2 group changed little. And mPAP ((26.1±1.4) mmHg) was significantly higher than that in sham operation group (P<0.05) while the difference in RVHI between OVX+ Hypoxia+ E2 (0.267±0.040) and sham operation groups had no statistical significance (P>0.05). Compared with Sham operation group, the expression levels of ACE, AngⅡ and AT1 in pure OVX, pure hypoxia and OVX+ hypoxia groups rose markedly (allP<0.05). However, the OVX+ E2 and OVX+ hypoxia+ E2 groups had no obvious change (allP>0.05).

The intervention effect of E2 for hypoxic pulmonary hypertension may be partly mediated by the down-regulated expressions of ACE and AT1 in lung tissue resulting in the reduced activity of ACE-AngⅡ-AT1 axis.

To explore the effects of gender on pathology and pulmonary vascular reactivity in chronic hypoxic pulmonary hypertension (HPH) in mice.

HPH was induced by a 4-week exposure of male and female mice (8 weeks old C57BL/6, n=15 each) to chronic hypoxia (10%O₂). Normoxic controls were established both in male and female groups (n=15 each). Right ventricular systolic pressure (RVSP) and Fulton index were detected. Isolated pulmonary artery ring contraction induced by high potassium (K⁺) and U-46619 was recorded and compared between two groups.

Chronic hypoxia induced pulmonary hypertension after 4 weeks. RVSP significantly increased both in hypoxic female and male groups (normoxic vs hypoxic: (23.40±0.16) vs (31.46±2.33) and (24.71±0.44) vs (33.66±1.38) mmHg (1 mmHg=0.133 kPa), P=0.029 and P<0.001). However, there were no inter-group differences (P=0.447). The Fulton index of hypoxic female and male mice was higher than normoxic counterparts (P=0.001, P<0.001). But there were no gender differences (P=0.471). Contraction of high K⁺ and U-46619 was calcium ion (Ca²⁺)-dependent and decreased markedly without calcium (P<0.001,P=0.007). High K⁺ and U-46619-induced contraction of pulmonary artery was concentration dependent and greater in chronic hypoxic female (P=0.002, P<0.001) and male mice (bothP<0.001). But no differences existed between male and female mice in high K⁺ (P=0.657) or U-46619 (P=0.751)-induced contraction.

No significant correlation exists between gender and occurrence and severity of pulmonary hypertension or pulmonary artery vascular reactivity in HPH mice.

To explore the risk and protective factors for pulmonary hypertensive crisis (PHC) in patients with idiopathic pulmonary arterial hypertension (IPAH).

A retrospective study was performed for 65 patients with a diagnosis of IPAH between January 2010 and December 2013. According to clinical manifestations, they were divided into two groups of susceptibility and non-susceptibility to PHC. Clinical and hemodynamic parameters were analyzed in univariate and multivariate manners.

Among them, there were 32 males and 33 females with a mean age of (14.4±12.3) (10/12-47.3) years. Twenty-three patients had typical manifestations of PHC and 18 of them were induced by exercises. Univariate analysis revealed that the proportion of patients with World Health Organization (WHO) functional class Ⅲ-Ⅳ in PHC-susceptible group was significantly higher than PHC-nonsusceptible group (60.9% vs 23.8%, P=0.003) while the percentage of patent foramen ovale in PHC-susceptible group was significantly lower than PHC-nonsusceptible group (8.7% vs 45.2%, P=0.003). In patients with WHO functional classⅠ-Ⅱ, hemodynamic variables including the decline of pulmonary arterial pressure and positive rate in vasoreactivity testing in PHC-susceptible group were significantly higher than PHC-nonsusceptible group. In patients with WHO functional class Ⅲ-Ⅳ, baseline pulmonary arterial pressure and mean right atrial pressure in PHC-susceptible group were significantly higher than those in PHC-nonsusceptible group. Multivariate Logistic regression analysis revealed that, for those with WHO functional class Ⅲ-Ⅳ (OR=23.45, 95%CI: 2.85-193.09) and the decline of systolic pulmonary arterial pressure in vasoreactivity testing (OR=1.12, 95%CI: 1.04-1.22) were independent risk factors for PHC in IPAH patients while patent foramen ovale (OR=0.01, 95%CI: 0.00-0.52) was a protective factor.

PHC in IPAH patients is correlated with WHO functional class, pulmonary vascular reactivity, baseline pulmonary arterial pressure and patent foramen ovale. And exercise is the most common stimulus to PHC.

To explore the clinical characteristics of adrenal gland trauma.

A retrospective review was performed for 17 patients presenting with adrenal gland injury diagnosed by computed tomography (CT). There were 11 males and 6 females with an average age of 14-60 (38±12) years. The injuries occurred as the consequence of motor vehicle crash (n=13)and secondarily to a fall (n=4). The average time from accident to admission was 5.0±4.1 hours and the average injury severity score (ISS) 31.5±10.3. Among 9 patients with throat injuries, there were pulmonary contusion, hematopneumothrax and rib fracture, followed by extremity fracture (n=8) and pelvis fracture (n=7). Additionally, 3 patients had injuries to vertebral column and 4 suffered closed cranial injury. There were 3 patients with liver injury, including subcapsular hematoma (n=2) and laceration (n=1). The urinary related injuries included renal contusion and laceration (n=5) and urethral injury (n=1). Among them, 15 had injuries to right adrenal glands and 2 to left ones. The CT findings of adrenal trauma were adrenal contusion and focal hematoma. All patients received conservative treatment.

No patient died. The complications of urinary tract infection(n=6), deep vein thrombosis (n=3), pneumonia (n=3) and gastrointestinal ulceration (n=2) improved with conservative treatment. Vital signs were all stable after 1 week treatment except for 1 patient operated for intracranial hematoma. The average follow-up period was 2.0-12.0 (5.5±2.7) weeks for 11 patients. The re-examination of CT showed a absorption of hematoma. And 2 cases had a complete absorption.

Adrenal gland injury is rare and there is a right-sided preponderance. It is associated with high injury severity. For a lack of obvious clinical manifestations, missed diagnosis is frequently made. CT scan is the first-choice diagnostic tool for adrenal gland injury. Conservative treatment is often satisfactory and hormonal supplement unnecessary.

To explore the clinical outcomes of open distal radius fractures managed with bridging external fixator and Kirschner-wire.

Retrospective reviews were conducted for 9 patients with open distal radius fractures managed with bridging external fixator and Kirschner-wire between October 2009 and October 2010. There were 6 females and 3 males with a mean age at injury of 60.0 (17-79) years. The mechanisms were fall from standing height (n=5), fall from height >2 meters ( n=1) and traffic accident (n=2). The average time from injury to operation was 7.2 (4-9) hours. According to the Gustilo and Anderson classification, the grades were Ⅰ (n=2), Ⅱ (n=3) and ⅢA (n=4). Two patients had additional injuries in other areas. Four patients had associated tendon, nerve or artery injury around wrist. One patient had ipsilateral forearm compartment syndrome. The clinical and radiological outcomes were followed.

According to the AO/OTA classification, there were A2 (n=1), A3 (n=4) and C3 (n=4). Seven patients had distal ulnar fractures and 4 suffered a dislocation of DRUJ (distal radial ulnar joint). All distal radius fractures were fixed with bridging external fixator and Kirschner-wire. Percutaneous pin fixation of DRUJ was performed in 4 patients because of instability of radial or ulnar fractures. Nine patients were followed up for an average period of 2.8 (1.9-3.5) years. According to the modified Green and O′Brien score, the clinical outcome at the time of final follow-up was graded as excellent (n=2), good (n=4), fair (n=1) and poor (n=2). All fractures were healed. The complications included fixation failure and revision (n=1), fixator pin site infection (n=2) and Kirschner-wire loosening (n=5).

The outcomes of open distal radius fractures managed with bridging external fixator and Kirschner-wire are unsatisfactory. And this fixation method may not be optimal for all open distal radius fractures.

To evaluate the efficacies of transcutaneous stimulation of genioglossus on remaining mild-to-moderate obstructive sleep apnea syndrome (OSAS) after uvulopalatopharyngoplasty (UPPP).

A total of 22 patients diagnosed with mild-to-moderate OSAS by polysomnography (PSG) after UPPP were recruited from Sleep Center of First Affiliated Hospital, Nanjing Medical University from February 2013 to October 2013 and underwent transcutaneous stimulation of genioglossus therapy at night. Prior to and during treatment overnight polysomnography examination was performed. Moreover, the sleepiness of patients was assessed according to the Epworth sleepiness scale (ESS) before and after treatment. Comparison was made to observe the effects of treatment on PSG parameters and daytime ESS.

Compared with pre-treatment, nocturnal apnea hypopnea index (AHI) (9.3±4.2 vs 18.3±6.8), microarousal index (MAI) (6.5±3.8 vs 11.2±4.8), radio of duration pulse oxygen saturation (SpO₂)<90% to total sleep time (T90) ((5.1±4.0)% vs (9.5±4.0)%) and score of daytime ESS (8.8±3.3 vs 9.4±3.1) all significantly decreased (allP<0.01) while mean SpO₂ ((95.5±1.0)% vs (94.4±1.1)%) and minimal SpO₂ ((88.6±2.9)% vs (84.9±4.6)%) were both significantly elevated (both P<0.001). None of them experienced obvious discomforts during treatment.

Submental transcutaneous electrical stimulation of genioglossus is an effective treatment for remaining mild-to-moderate OSAS after UPPP surgery.

To explore the effects of walking exercise during late trimester on pregnancy outcome of low-risk primipara.

A prospective randomized controlled study was conducted for 123 cases of low-risk primipara who had regular prenatal care at Shengjing Hospital, China Medical University from July 2012 to June 2013. And informed consent was obtained. The control group included 116 cases of other low-risk primipara in the same period. Except that the experimental group had regular structured walking exercise from 34 weeks of gestational age to delivery, other consulting guidance were the same as the control group. The inter-group differences, such as delivery mode, mean body weight gain per week after 34 weeks of gestation, duration of labor, labor pain perception, neonatal weight and neonatal birth condition, were detected and analyzed.

Finally there were 13 and 8 dropouts in experimental and control groups respectively. For two groups, the rate of caesarean section was 12.7% and 18.5%, the mean body weight gain per week after 34 weeks of gestational age (0.41±0.13) and (0.56±0.09) kg, the labor pain score are 6.1±1.9 and 7.6±2.3, the duration of labor (12±4) and (15±6) h, the neonatal birth weight (3.4±0.3) and (3.7±0.6) kg and the rate of macrosomia 4.5% and 7.4% respectively. The differences had statistical significance (P<0.05). The rate of preterm birth was 5.5% and 4.6%, the rate of premature rupture of membrane 15.5% and 13.9% and the rate of neonatal asphyxia 2.7% and 3.7% respectively. The differences had no statistical significance (allP>0.05).

Simple, safe and effective, walking exercise during late trimester may improve the pregnancy outcomes of low-risk primipara.

To explore the characteristics of esophageal motility in patients with non-erosive disease (NERD) and reflux esophagitis (RE).

For this single-blind retrospective study, adult patients with typical reflux symptoms underwent esophageal manometry from January 2008 to December 2011. Their course of disease, age, gender, esophageal manometry, hiatal function and 24 h pH monitoring were analyzed by univariate and binary Logistic regression analyses.

A total of 244 adult patients (RE=85, NERD=159) were enrolled into this study. Age and course of disease were significantly higher in RE group than those in NERD group ((50.7±1.2) vs (46.5±0.9) yrs, (4.8±0.5) vs (3.4±0.3) yrs, both P<0.05)while no difference existed in gender (P>0.05). Lower esophageal sphincter (LES) length, LES pressure, peristaltic contraction amplitude of distal esophageal body and rate of effective peristaltic contraction of distal esophageal body were significantly lower in RE group than those in NERD group ((1.91±0.06) vs (2.19±0.04) cm, (6.98±0.31) vs (8.54±0.31)mmHg, (56.76±3.21) vs (75.57±3.47) mmHg, 54.1%(46/85) vs 76.1%(121/159), allP<0.05). However, there was no inter-group difference in LES relaxation rate and upper esophageal sphincter (UES) function (bothP>0.05). Rate of hiatal hernia(HH)and hiatal flabby(HF) in RE group significantly increased versus NERD group (23.5% (20/85) vs 1.9% (3/159), 24.7% (21/85) vs 11.3% (18/159), bothP<0.05). Positive rate of 24 h esophageal pH monitoring, reflux number and percent of reflux were significantly higher in RE group than those in NERD group(59.1% (26/44) vs 32.5%(38/117), 71.0(13.5, 119.0) vs 25.0 (8.0, 56.0), 5.0% (0.4%, 10.9%) vs 1.1% (0.2%, 5.0%), allP<0.05). Binary Logistic regression analysis showed that LES length, rate of effective peristaltic contraction of distal esophageal body and HH were risk factors for RE(OR=2.781, 0.037, 21.722, 95%CI: 1.057-7.313, 0.009-0.152, 5.433-86.845).

Impaired anti-reflux barrier at esophagogastric junction and impaired clearance of esophageal body are important causative factors for RE. And abnormal anatomy in esophagogastric junction should raise alerts.

To retrieve the epidemiological literature of end stage renal hemodialysis patients.

A total of 8 108 chronic renal failure (CRF) patients on first-time dialysis in Shanxi province during January 2010 and December 2013 were surveyed. Their clinical data were registered into the Chinese national renal data system.

In Shanxi province, the number of hemodialysis patients increased annually. The incidence rate between 2010 and 2013 was 46.62, 53.44, 62.61 and 62.93 pmp, respectively. The first three primary causes of CRF in incident hemodialysis patients were glomerulonephritis, diabetic nephropathy and hypertensive nephrosclerosis. The first vascular access in CRF patients at the beginning of hemodialysis was temporary central venous catheter (53.3%) and then primary arteriovenous fistula (41.2%). Anemia was one of the most common complications of incident hemodialysis patients, followed by hypertension and bone and mineral disorders, etc. Cardiovascular and cerebrovascular incidences were the leading causes of death. Those with end stage renal disease (ESRD) were between the ages of 40-49 and 50-59.

In Shanxi province, the number of hemodialysis patients rises annually. The incidence of diabetic nephropathy and hypertensive nephrosclerosis rise with years. Timely hemodialysis and improvement are required.

To explore the relationship between selenoprotein P (SEPP) and insulin resistance in subjects with normal glucose tolerance and type 2 diabetes mellitus.

A total of 156 subjects with newly onset diabetes and 64 subjects with normal glucose tolerance were enrolled. Fasting plasma glucose (FPG), fasting insulin (FIN), lipid profile and SEPP level were measured and height, weight and blood pressure were recorded. Insulin resistance index was calculated by homeostatic model assessment (HOMA-IR).

The SEPP level was significantly higher in obese and non-obese diabetic groups than control group ((4.43±1.95), (3.01±1.20) vs (2.34±2.30)mmol/L, both P<0.01). The SEPP level was significantly higher in obese subgroup of diabetic group than non-obese subgroup (P<0.05). The SEPP level was positively correlated with FIN, FPG, body mass index (BMI), triglycerides (TG) and HOMA-IR (r=0.401, 0.202, 0.420, 0.239, 0.445, P<0.05) and negatively with ISI (r=-0.414, P<0.01). Multivariate regression analysis demonstrated that SEPP level was independently correlated with insulin resistance (β=0.293, P<0.01). And the independent factors for ISI were systolic pressure, HbA1c and SEPP level (β=-0.195, -0.185 and -0.246, P<0.05).

Serum SEPP level may be an independent risk factor for insulin resistance regardless of age, blood pressure or lipid profile.

To assess the effects of neoadjuvant chemoradiotherapy on survival outcomes of low rectal cancer after sphincter-preserving or removing surgery.

A total of 135 patients with rectal cancer within 10 cm from anal verge after neoadjuvant chemoradiotherapy were enrolled into this retrospective study from 2005 to 2012 at a single institute. There were 79 males and 56 females with a mean age of(58±12)years and an average distance of(5.2±2.1)cm from anal verge. The effects of gender, age, distance of tumor from anal verge, surgical procedure, T-stage downstaging, lateral resection margin and post-treatment lymphatic node status on 3-year disease-free survival (DFS) were examined.

The overall 3-year DFS was 85.2%(115/135). Among 95 sphincter-preserving operations, there were anterior resection (n=79), anterior perineal plane for ultra low anterior resection (APPEAR) technique (n=12), Hartmann procedure (n=3) and Parks procedure (n=1). Among 40 sphincter-removing operations, there were abdominoperineal resection (APR) procedure (n=39) and intersphincteric resection(ISR) (n=1). The survival of patients undergoing sphincter-preserving or removing procedures did not differ in 3-year DFS(85.3%(81/95)vs 85.0%(34/40), χ ²=0.000, P=0.985). Lateral resection margin and post-treatment lymphatic node status significantly affected DFS. The differential level from anal verge showed a trend of close relationship to 3-year DFS (81.5%(22/27)for 2-3 cm, 82.5%(47/57) for 4-5 cm vs 95.1%(39/41) for 6-7 cm), but without statistic significance (χ²=3.111, 3.522; P=0.078, 0.061). The survival rate for patients with sphincter-preserving at 6-7 cm from anal verge was significantly higher than that at 4-5 cm(95.0%(38/40) vs 79.5%(31/39), χ ²=4.227, P=0.039), but showed no differences to that with sphincter-removing at 2-3 cm from anal verge(81.0%(17/21), χ ²=2.864, P=0.091). The multivariate analysis showed that post-treatment lymphatic node status was the only prognostic factor to 3-year DFS(Wald=4.454, P=0.035).

Lateral resection margin and post-treatment lymphatic node status play an important role on DFS for patients with low rectal cancer after neoadjuvant chemoradiotherapy. The distance from anal verge is correlated with 3-year disease-free survival. Patients with tumor at 4-5 cm from annal verge can not benefit for survival when they get sphincter-preserving operations.

To explore the memory characteristic in boys with attention-deficit/hyperactivity disorder (ADHD) plus learning disability (LD).

A total of 97 ADHD boys with comorbid LD (ADHD+ LD), 97 ADHD boys without comorbid LD (ADHD-LD) and 97 healthy controls (based on the criteria of DSM-Ⅳ) were recruited from the outpatient clinic of Peking University Sixth Hospital from December 2003 to September 2012. Individuals across three groups were matched by ages, intelligence quotient (IQ) and ADHD subtypes. The Wechsler Memory Scale(WMS) was used to access the characteristics of several memory domains.

ADHD + LD group performed the worst and control group the best in memory quotient (MQ)(90±15 vs 98±14 & 104±14)and long-term memory domain ((36.0±10.2)vs (42.1±7.8) & (45.6±6.7) score, all P<0.05). ADHD+ LD group scored significantly lower than the control group in short-term memory ((53.0±9.2)vs (58.0±9.7) score,P<0.05) and immediate memory domains ((10.0±3.3)vs (11.3±3.5) score,P<0.05). However, ADHD+ LD group scored slightly but not significantly lower than the ADHD-LD group ((54.9±10.7), (10.8±3.2) score,P>0.05). In most subscales of WMS, ADHD+ LD group scored significantly lower than both ADHD-LD and control group in current information and orientation, mental control(1→100), mental control(100→1)and associate learning subscales((8.8±3.1)vs(10.0±3.0)&(9.9±2.3)score, (8.7±4.1)vs(10.0±3.9)&(11.1±3.6)score, (10.7±3.9)vs(12.9±2.8)&(13.7±2.2)score, (9.8±3.1)vs(10.8±2.6)&(11.1±2.1)score, allP<0.05). In mental control (accumulation) subscale, all pairwise comparisons were statistically significant(allP<0.05). In subscales of figure memory, visual reproduction and digit span, ADHD+ LD scored significantly lower than the control group (allP<0.05), but not the ADHD-LD group (allP>0.05).

Boys with ADHD comorbid LD show deficits in overall memory function and long-term memory while short-term memory is partially damaged. Impairment in immediate memory is not detected.

"The 8th Beijing Five Continents International Conference on Cardiovascular Diseases (FICC 2014) and the 30th Anniversary Celebration of Beijing Anzhen Hospital Affiliated to Capital Medical University" were held at Beijing International Convention Center on April 11-13, 2014. The conference was jointly sponsored by Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing Institute of Cardiopulmonary and Vascular Diseases, and Beijing Wu Yingkai Medical Development Foundation. With the theme of "Co-gathering, Integration and Win-win", the conference highlighted the latest progress in the diagnosis, treatment and prevention of cardiovascular diseases and related fields.

To explore the effects of fluvastatin on expression of p38 mitogen-activated protein kinase (p38MAPK) in renal tissue of chronic graft versus host disease (cGVHD) lupus nephritis in mice.

Mice were randomly divided into 4 groups of model, low-dose fluvastatin intervention (5 mg·kg^-1·d^-1), high-dose fluvastatin intervention (10 mg·kg^-1·d^-1) and normal control. The 24 h total amount of urine protein was evaluated by biuret reaction colorimetric assay. And the protein and mRNA expression levels of p38MAPK, p-p38MAPK and TGF-β1 in renal tissue were detected by immunohistochemistry, Western blot and reverse transcription-polymerase chain reaction (RT-PCR) respectively.

Compared with the normal control group, 24 h total amount of urine protein, protein and mRNA expression levels of p38MAPK, p-p38MAPK and TGF-β1 increased significantly in the model group respectively ((7.84±0.36) vs (1.15±0.15) mg/24 h, 0.81±0.03 vs 0.50±0.01, 0.69±0.02 vs 0.10±0.01, 0.76±0.02 vs 0.28±0.02, 0.84±0.04 vs 0.25±0.02, 0.82±0.04 vs 0.12±0.02, allP<0.01). Fluvastatin treatment suppressed markedly their increased expressions (P<0.05). And high-dose fluvastatin treatment suppressed more significantly than low-dose group (P<0.05).

The renal protection effect of fluvastatin may be achieved by inhibiting the signal pathway of p38MAPK.

To evaluate the feasibility and safety of endoscopic closure of esophageal perforation with an over-the-scope clip (OTSC) system in a surviving canine model.

Esophageal perforations (20-mm diameter) were created by an endoscopic needle-knife in 10 dogs. Then the perforations were closed by the OTSC system. And gastroscopy was performed weekly to evaluate the postoperative perforation healing.

Esophageal perforations could primarily be closed with one OTSC in each experimental dog. The mean handling time was 24 (18-33) min. All animals survived without postoperative complications. The retention of OTSC was observed in all dogs at the end of 3 weeks.

The OTSC system can reliably close esophageal perforations without complications.

To verify the function of magnetic and hydrodynamic suspension centrifugal ventricular assist device in a sheep model.

The device was implanted into left ventricular apex on beating hearts. The outflow graft of each device was anastomosed to descending aorta in 11 animals. Hematologic, biochemical and blood clotting tests before and after surgery were performed. The data of pump functions were collected continuously.

Among them, there were death from ventricular fibrillation (n=3), acute pulmonary edema (n=1) and left ventricular thrombus and molar cardiac muscle (n=5). One animal survived for 75 days and died from bacterial infection after pumping for 59 hours. During assistance for 120 days, the flow rate was 3.0-3.4 L/min. All hematologic and biochemical parameters were within normal ranges in one sheep. The walking sheep wore the controller and lithium battery with a blood pump. Neither mechanical wearing nor thrombus formation was observed for inflow and outflow conduits or pump interior.

The magnetic and hydrodynamic suspension centrifugal ventricular assist device demonstrates excellent hemocompatibility and reliability. And there is a great prospect of clinical success.

The Ommaya sac was originally used as a device for intratumoral chemotherapy of craniopharyngioma. The purpose of therapy was achieved by direct injection of drugs into the ventricles or cystic tumors^[1]。 In recent years, the clinical application of Ommaya sac has gradually expanded. This study summarized the treatment of ventricular hemorrhage, hydrocephalus, intracranial infection, subdural effusion and other diseases by Ommaya sac placement in the Department of Surgery of the First People's Hospital of Taicang City, Jiangsu Province since June 2008, and achieved good curative results. The summary report is as follows.

functional gastrointestinal diseases (FGIDs) refer to the presence of digestive tract symptoms but cannot be explained by organic lesions or biochemical abnormalities. Clinically, non-erosive reflux disease (NERD), functional dyspepsia (FD), irritable bowel syndrome (IBS) and functional constipation are the most common^[1,2]。 FGIDs often have a long medical history, recurrent attacks, seek medical treatment everywhere, and there is no specific drug for treatment, which seriously affects the quality of life of patients and consumes a lot of health resources. In recent years, FGIDs have received increasing attention, but their exact pathogenesis is unclear. The research progress of functional gastrointestinal diseases in recent years is introduced as follows.

Human albumin has been used clinically for decades to maintain colloidal osmotic pressure and blood volume. However, the results of crystalline fluid supplementation and albumin supplementation in critically ill patients are not consistent. Results from a recent large-scale, multicenter, open, randomized controlled trial showed that maintaining serum albumin levels ≥30 g/L did not improve the prognosis of patients with severe sepsis (Caironi P, Tognoni G, Masson S, et al. Albumin replacement in patients with severe sepsis or septic shock [J]. N Engl J Med, 2014, 370: 1412 – 1421.).

In European and American countries, the incidence of bladder cancer ranks fourth among malignant tumors in men, after prostate cancer, lung cancer and colon cancer, and after the 10th among malignant tumors in women^[1]。 There were approximately 73,510 new cases of bladder cancer (55,600 males and 17,910 females) and 14,880 deaths (10,510 males and 4,370 females) in the United States in 2012^[2]。 The incidence of bladder cancer is increasing in some cities in China^[3]。 Moreover, the fatality rate of bladder cancer in urban residents is significantly higher than that in rural areas. In 2009, the age-standardized mortality rate of bladder cancer in urban residents in China was 3.79/100,000 for men and 1.30/100,000 for women; In rural areas, the rate is 2.42/100,000 for men and 0.81/100,000 for women^[4]。 For the same stage of bladder cancer, the prognosis of women is worse than that of men. The incidence of bladder cancer in men is higher than that in women due to smoking habits and occupational factors. Sex hormones may be an important reason for this outcome^[5]。 Non-muscle invasive bladder cancer (NMIBC) accounts for 70% of all bladder tumors, and is the population of bladder cancer patients faced in most clinical work.

Pulmonary hypertension is a kind of disease characterized by progressive increase of pulmonary vascular resistance, and its disability and mortality rate are high. Due to the lack of specific clinical symptoms, missed diagnosis and misdiagnosis often occur in clinical diagnosis and treatment. Right cardiac catheterization is the gold standard in the diagnosis of pulmonary hypertension, but its invasive nature limits its clinical application. Although transthoracic color ultrasound can estimate pulmonary artery pressure noninvasively, it is easily affected by operator experience and so on^[1]。 Seeking non-invasive, convenient and accurate examination to reflect the disease progress of pulmonary hypertension is one of the research hotspots in recent years. Among them, pulmonary hypertension-related biomarkers have become the focus of research. The clinical applications of the most important biomarkers at present are summarized as follows.

Hematopoietic stem/progenitor cell (HSPC) mutations are closely related to the occurrence and development of myelodysplastic syndrome (MDS)^[1]。 MDS is accompanied by a variety of cytogenetic and molecular defects, which lead to a high degree of heterogeneity in MDS^[2,3]。 Due to the heterogeneity of MDS, no single model can mimic the phenotype of MDS as a whole. Animal models are effective tools and useful preclinical experimental platforms for simulating and studying human diseases. Therefore, it is very important to establish a mouse model of MDS to study its pathogenesis, treatment and prognosis.

A 39-year-old female was admitted on 19 October 2004. The left breast mass was found for half a year, occasionally tingling; The whole body is covered with coffee stains of varying sizes and soft nodules the size of soybeans near skin color, without any discomfort, and has a medical history of more than 20 years. Specialist physical examination: A 4.0 cm ×3.5 cm mass was accessible in the upper quadrant of the left breast, hard in texture, unclear in boundary, fixed, and no swollen lymph nodes were found under both axillaries and above and below the clavicle. Mammography X-ray examination and ultrasound revealed space-occupying lesions in the left breast. Pathological diagnosis of biopsy in an outside hospital in 1993: neurofibromatosis without any treatment. Invasive lobular carcinoma of left breast (Figure 1)。 Diagnosis: Left breast cancer (T₂N₀M₀), clinical stage: stage I. No history of neurofibroma was found among their relatives and a family history of breast cancer was denied. Modified radical mastectomy for left breast cancer was performed on 21 October 2004. Postoperative pathology: invasive lobular carcinoma of left breast, axillary lymph nodes 0/12 (–), ER (+), PR (+), C – erbB – 2 (–). After operation, he was treated with CMF regimen chemotherapy for 6 cycles and tamoxifen endocrine therapy, but he was cured and discharged without radiotherapy. No recurrence of breast cancer was observed after 9 years of follow-up.