Volume 94  ·   Issue 44  ·  2014

Dermatoscopy is a non-invasive examination technique, which can observe the microstructure of the epidermis, the junction between epidermis and dermis, and the dermal papilla, thus closely linking macroscopic dermatology with microscopic dermatopathology. Dermoscopy has been widely used in the diagnosis and differential diagnosis of pigmented and non-pigmented skin diseases because of its convenience, non-invasiveness and high diagnostic accuracy. The application and research of dermatoscope reached a climax in the 2000 Internet Dermatoscopy Conference and the first World Dermatoscopy Conference held in Rome in 2001, and it was rapidly spread all over the world. The clinical application of dermatoscope increases the correct diagnosis rate of skin diseases by 30% compared with the simple naked observation^[1]Combined with the clinical manifestations visible to the naked eye and the histopathology of the skin lesions, it provides intuitive, objective and accurate clues for the diagnosis of dermatology, which is of great significance to the development of dermatology field. Because of the particularity of the nail anatomy and the inconvenience of histopathological materials, dermoscopy provides a good prospect for non-invasive diagnosis of nail diseases. Dermoscope can not only observe the nail plate, but also observe the micro-structure and blood vessels of the proximal nail fold, nail matrix, nail bed and free nail edge. According to this, the diagnosis and differential diagnosis can be confirmed, and the activity degree of disease and the therapeutic effect can be evaluated.

China's clinical research scale is large, the level is low, and the influence in international academic circles is small. This situation needs to be changed urgently. The "Twelfth Five-Year Plan" support plan of the Ministry of Science and Technology has arranged the "Demonstration Application Research on the Construction of Collaborative Network for Clinical Medical Research" project, in which the first batch of 13 national clinical medical research centers in 6 subject fields has passed the evaluation and started, and the second batch of 9 national clinical medical research centers in 3 subject fields has passed the selection and is being announced. The core of this project is to establish a collaborative network for clinical medical research (hereinafter referred to as the collaborative network). Collaborative network will change the clinical research model and lay the foundation for the leap-forward development of clinical research in China and better participation in international academic competition^[1]。 The author participated in the whole process of project evaluation, and realized that collaborative network has many important characteristics and advantages, which are necessary to discuss and summarize. Therefore, this paper expounds the scientific basis of collaborative network to promote the development of clinical research from five dimensions, so as to lay a good foundation for better organization and implementation of collaborative network construction.

Skin surgery is an inherent sub-specialty of dermatology. At present, it is not only widely carried out in dermatology departments and dermatology hospitals of Class III A hospitals, but also involved in dermatology business in some hospitals below Class II. Due to the rapid development of dermatological surgery technology and the rapid increase of practitioners in recent years, some problems have been exposed in the development of dermatological surgery, such as large cognitive differences in subject categories, mixed qualifications of practitioners, insufficient standardization of talent training, etc. In order to promote the scientific and sustainable development of dermatology, promote the standardization of related medical behaviors, and fulfill the purpose of "service, coordination, self-discipline, rights protection, supervision and management" of industry organizations, the Dermatology Subspecialty Committee of Dermatology Branch of Chinese Medical Doctors Association took the lead in drawing up the expert consensus on the discipline system and standard construction of dermatology in China as follows.

To explore the effects of cell cycle distribution and expression of cell cycle related proteins before and after transglutaminase 1 (TGM1) gene silencing by small interfering RNA (siRNA) in immortalized human keratinocytes (HaCaT cells).

Before and after RNA interference (RNAi) silencing TGM1 gene expression in HaCaT cells, the changes of cell cycle status were detected by flow cytometry. And the expressions of cell cycle related proteins cyclin D1, cyclin B1 and CDK4 were detected by immunocytochemistry and Western blot.

After TGM1 silencing, the HaCaT cells increased in G₀/G₁ phase (78.27% ±1.83% vs 56.84 %±2.72% and 57.19%±3.72%, both P<0.05) while decreased in S phases (32.78%±5.48% vs 57.32%±2.91% and 55.71 %±2.84%, bothP<0.05) and G₂/M phases(3.66%±0.30% vs 9.39%±0.68% and 9.77%±0.52%, both P<0.05). Moreover, arrest of cell cycle was induced in S phase. After TGM1 silencing, cell proliferation was significantly inhibited while wild-type TGM1 displayed an accelerated growth rate. Inmmnohistochemistry indicated that cyclin D1, cyclin B1 and CDK4 had a strongly negative expression after transfecting with TGM1 siRNA. Western blot indicated that a very low endogenous expression of cyclin D1, cyclin B1 and CDK4 proteins was observed after transfecting with TGM1 siRNA.

TGM1 siRNA may block the cell cycle of HaCaT cells. It suggests that TGM1 expression in HaCaT cellsare closely related with cell cycle.

To explore the serum levels of leptin, adiponectin and sex hormone and their relationship in benign acanthosis nigricans of males.

A total of 15 males patients with benign acanthosis nigricans were recruited from January 2010 to December 2013. The serum concentrations of leptin, adiponectin and sex hormone were measured with radioimmunoassay and enzyme-linked immunoabsorbant assay (ELISA) respectively.

As compared with normal control, the values of body mass, body mass index and %Fat were much higher in benign acanthosis nigricans of males ((88±6) vs (62±5) kg, (31.7±2.1) vs (22.2±2.7) kg/m^2, 33.3%±2.6% vs 29.0%±5.8%, all P<0.05), leptin was much higher ((8.0±1.1) vs (4.5±1.5) μg/L,P<0.01), adiponectin was much lower ((27.7±4.8) vs (38.6±5.8) μg/L,P<0.01), estradiol and testosterone were much higher ((112±28)vs(38±7)pmol/L, (7.3±1.9) vs (3.9±2.0) nmol/L, bothP<0.01), luteinizing hormone was much lower ((128±11) vs (155±24) U/L,P<0.01). And prolactin and follicle stimulating hormone were not significantly different between two groups (bothP>0.05).

Benign acanthosis nigricans is associated with abnormal levels of lepin, adiponectin and sex hormone. And there may be some relationship between the abnormal levels of lepin and sex hormone in benignacanthosis nigricans.

To evaluate health-related quality of life (HRQOL) in patients with systemic sclerosis (SSc) using health assessment questionnaire-disability index (HAQ-DI), visual analog scale (VAS) and scleroderma assessment questionnaire (SAQ).

The questionnaires of HAQ-DI, VAS and SAQ were administered to 50 controls and 90 SSc patients from September to December 2013. And SSc patients were also evaluated for subset (limited & diffuse SSc), age, disease duration, autoantibodies and skin & internal organ involvement.

The physical summary scores of HAQ-DI in dressing, cleaning and hand functions domains were higher in SSc patients than those in controls (all P<0.05). As for VAS, the specific clinical manifestations(Pain, 0.60(0.20-1.40); Raynaud's phenomenon, 9.00(4.00-11.00); finger ulcers, 1.00(0.00-5.00); gastrointestinal symptoms, 5.00(1.00-6.50); respiratory symptoms, 3.00(0.00-6.00)) of SSc patients impacted their HRQOL. SAQ showed higher scores in blood vascular, respiratory, digestive and musculoskeletal systems for SSc patients(1.00(0.75-1.50), 0.50(0.33-0.67), 0.40(0.20-0.80), 0.13(0.00-0.38) vs 0.00(0.00-0.00), allP<0.05).

HRQOL is impaired in patients with SSc, especially in physical domains. And higher scores in SScpatients with specific organ involvement suggest that severe disease has worse HRQOL.

To describe the dermoscopic patterns of scalp psoriasis and seborrheic dermatitis and explore the roles of dermoscopy in their diagnosis and differential diagnosis.

A total of 40 patients with scalp psoriasis (n=20) and seborrheic dermatitis (n=20) were recruited from Department of Dermatology, Peking Union Medical College Hospital from December 2013 to May 2014. They were examined both dermoscopically and histopathologically. And characteristic dermoscopic features were evaluated. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for predefined dermoscopic criteria in relation to the diagnosis of two diseases.

The most significant dermoscopic features of scalp psoriasis included dotted vessels (10/20, 50%), glomerular vessels (13/20, 65%), red loops (16/20, 80%), hairpin vessels (17/20, 85%), white scales (10/20, 50%) and punctate hemorrhages (12/20, 60%). In contrast, seborrheic dermatitis was characterized by arborizing vessels (16/20, 80%), atypical red vessels (13/20, 65%), featureless areas (20/20, 100%) and honeycomb pigment (9/20, 45%)(all P<0.05).

Scalp psoriasis and seborrheic dermatitis have different dermoscopic patterns. Dermoscopy may be valuable for clinical diagnosis and differential diagnosis of scalp psoriasis and seborrheicdermatitis.

To evaluate the effects of statins on the short-term prognosis in elderly patients with acute kidney injury (AKI).

The data of hospitalized elderly patients with AKI at our hospital from June 2010 to December 2011 were analyzed retrospectively. The etiology, characteristics, prognosis and relative risk factors were examined. They were divided into statin and non-statin groups according to whether or not statins were taken over 3 months before a diagnosis of AKI.

For 377 cases of elderly patients with AKI, serum creatinine (Scr) tmax was around 7.8 days and 2.06 times of peak increased in the level of Scr to baseline. About 24.7% of those were complicated with multiple organ dysfunction syndrome (MODS). Renal function fully recovered within 3 months after AKI in 206 cases (54.6%) of elderly patients with AKI. The renal function recovery rate of patients in statin group (n=145) was significantly higher than that of those in non-statin group (n=232) (P<0.01). And 121 case (32.1%) died within 3 months after AKI. At the end of 3 months after AKI, the doubling of Scr level in statin group was significantly lower than that in non-statin group (P<0.01). Logistic regression analysis showed that risk factors of mortality within 3 months in elders with AKI were significantly associated with infection and concurrent MODS. The doubling of Scr level after AKI in elders was significantly associated with the level of Scr at a diagnosis of AKI, MODS and the history of chronic kidney disease. The risk of doubling in Scr level was significantly reduced in patients of statin group after AKI (P=0.02, OR: 0.46; 95% CI: 0.24-0.9).

The risks of death in elderly patients with AKI are associated with infection and concurrent MODS. Long-term use of statin in elderly patients can significantly reduce the risk of doubling Scr level insurviving patients.

To explore the role of expressions of BRCA1 and BRCA2 protein in sporadic breast cancer.

Eighty-six cases of breast cancer and adjacent cancer tissues and 48 cases of breast hyperplasia surgical specimens were collected. And the immunohistochemical S-P method was employed for detecting the protein expressions of BRCA1 and BRCA2.

BRCA1 expression in breast cancer, breast cancer adjacent cancer tissues and positive rates in breast hyperplasia were 60.5%(52/86), 46.5%(40/86) and 100%(48/48). The difference was significant among three groups. The BRCA2 expression in breast cancer, breast cancer adjacent cancer tissues and positive rates in breast hyperplasia were 41.9%(36/86), 55.8%(48/86) and 95.8%(46/48) respectively. And the difference was significant among three groups. The expression of BRCA1 had no obvious relation with BRCA2 protein in breast cancer tissues (r=0.673, P>0.05).

The aberrant expressions of BRCA1 and BRCA2 protein plays a major role in the occurrence andprogression of sporadic breast cancer.

To investigate the effects of dexmedetomidine preconditioning attenuating remote lung injury of lower limb ischemia-reperfusion.

Sixty patients form Central Hospital of Cangzhou scheduled for lower limb operation with tourniquet from January 2014 to June 2014. Lumbar plexus combined with sciatic nerve block was performed guided by a nerve stimulator in both groups. All patients were randomly assigned to two groups, conventional general anesthesia group(R group, n=30) and dexmedetomidine preconditioning group (Pre-Dex group, n=30). In the group Pre-Dex, a dexmedetomidine intravenous infusion was started at a dose of 0.125 ml/kg(4 μg/ml) for 10 minutes before using tourniquet, whereas group R received an equivalent volume of normal saline. Blood samples were taken in femoral vein for 4 ml. Monocytes TLR4 expression and interleukin-6(IL-6), interleukin-8(IL-8), tumor necrosis factor-α(TNF-α) level were determinated 15 minute before tourniquet inflation(T ₁), 15 minute (T₂), 2 h(T₃), 6 h(T₄)and 24 h(T₅) after tourniquet release. Artery blood gas analysis, respiratory index and oxygenation index were measured by drawing off femoral artery for 2 ml.

Compare with T₁, RI in group R was higher at T₄ and OI was lower at T_3-5(P<0.01), and there were no significant differences in group Pre-Dex at T₂-T₅ about RI and OI(P>0.05); IL-8, IL-6 level at T₃-T₅ and TNF-α level at T₂-T₅ in group R were significantly higher. IL-8, IL-6 level at T₃-T₄ and TNF-α level at T₂-T₄ in group Pre-Dex were higher.Monocytes TLR4 expression was higher in group R at T₃-T₄(P<0.05). Compare with group R, RI in group Pre-Dex was lower and OI was higher at T₄(P<0.05); IL-8, IL-6 level at T₃-T₅ and TNF-α level at T₂-T₄ in group Pre-Dex was significantly lower(P<0.05). Monocytes TLR4 expression was lower in group Pre-Dex at T₃-T₅(P<0.05). IL-6, IL-8 level had positive correlation with TLR4 and RI((r=0.673, 0.647, 0.521, 0.457, P<0.01 ), but had negative correlation with OI in group R(r=-0.613, -0.578, P<0.01).

Dexmedetomidine preconditioning attenuate remote lung injury of lower limb ischemia-reperfusion, and the mechanism may be related to down-regulation of monocytes TLR4 expression and degradation of IL-6,IL-8 and TNF-α level.

To investigate the clinical usefulness of the low hemoglobin density (LHD) and other red blood cell parameters in screening for iron deficiency (ID) and distinguishing iron deficiency anemia (IDA) from other kinds of anemia.

Whole blood count (CBC) and parameters of iron metabolism of the patients with ID (n=251), IDA(n=155), anemia of chronic disease(n=90), renal anemia(n=184), acute hemorrhagic anemia(n=27) and non-anemia subjects(n=82) were analysed by Advia 2120 hematology analyzer, Hitachi 7180 automatic biochemical analyzer, Beckman-Coulter DxI 800 immunoassay analyzer. SPSS 13.0 software was applied to anylyze data.

The sensitivity of LHD in screening for ID was 67.2%, which was significantly higher than MCHC(38.8%). There was a sensitivity of 91.2% for ID screening by combination of LHD and RDW. LHD only increased greatly in IDA (14.9%) group, while had no increase in other anemia.

LHD is a reliable new marker with certain clinical usefulness. Combination of LHD and RDW is moresuitable for screening ID. LHD is also a useful marker to distinguish IDA from other kinds of anemia.

To explore the anesthetic effect and neonatal effects of dexmedetomidine combined with ropivacaine in the cesarean section under epidural anesthesia.

Between January 2012 and March 2013 at the First Affiliated Hospital with Nanjing Medical University, sixty parturients with a single baby at full term in vertex presentation scheduled for caesarean section under epidural anesthesia, were randomly divided into 3 groups (n=20 each) according to the random digits table: dexmedetomidine + ropivacaine (RD), fentanyl + ropivacaine (RF) and normal saline + ropivacaine (RN). After identification of the epidural space and a negative aspiration test for blood or cerebrospinal fluid, 15 ml of 0.75% ropivacaine, was administered epidurally in three the groups with addition of 1 μg/kg of dexmedetomidine in RD group, 1 μg/kg of fentanyl in RF group and 2 ml of normal saline in RN group. Recording the mean arterial pressure (MAP) and heat rate (HR) before anesthesia (T ₀), at 10 min (T₁) and 30 min (T₂) after the end of epidural administration, and at end of operation (T₃). Recording the onset time, maximum sensory analgesic level, time to maximum sensory analgesic level, time to two segmental dermatomal regressions, and time to chief complaint of postoperative pain. The modified bromage degrees, sedation scores and traction reaction were also assessed. The Apgar scores at 1 and 5 min were also recorded after delivery, and the blood samples were drawn from umbilical vein for gas analysis.

MAP, HR and the motor block (Bromage scale) were no statistics differences among the three groups(P>0.05). Compared with RN group, the onset time and the time to maximum sensory analgesic level were significantly earlier [(6.3±2.4), (8.7±2.3) min vs(10.9±2.7)min; (11.5±3.9), (16.2±4.6) min vs(19.8±5.2) min ,P<0.05], the time to two segmental dermatomal regressions and the time to chief complaint of postoperative pain were prolonged significantly[(22.5±4.6), (18.5±3.9) min vs(13.5±3.8)min; (415±92), (355±86) min vs( 273±68) min,P<0.05], level of sedation and degree of traction reaction were better in RD group and in RF group, and the incidence of shivering was lower in RD group (5% vs 40%,P<0.05), the incidence of dizziness was higher in RF group (20% vs 0,P<0.05). Compared with RF group, the same results were also seen about the onset time, the time to maximum sensory analgesic level, the time to two segmental dermatomal regressions and the time to chief complaint of postoperative pain, and the level of sedation was better, the incidence of drowsiness was lower in RD group. There were no statistics differences about both the blood gas analysis of umbilical vein and the Apgar scores at 1 and 5 min after delivery.

Administration of dexmedetomidine combined with ropivacaine can provide early onset, establishment of sensory anesthesia, much better sedation levels, decrease the degree of traction reaction and theincidence of shivering, and without adverse neonatal effects.

To determine the sensitivity of narrow-band imaging bronchoscopy (NBI) in the assessment of tumor extent and therapeutic strategy.

A total of 196 patients with imaging abnormalities for malignancy were examined with both white light bronchoscopy (WLB) and NBI (Olympus, EVIS LUCERA). Record the tumor infiltration, image and pathological results.

There were 152 male and 44 female with a mean age of 58 years. In 22 patients (13.1%), NBI revealed greater tumor extent than WLB alone. And tumor margins were >1 cm wider on NBI examination than on WLB. In 19 patients (11.3%), that finding influenced further therapeutic course, leading to greater resection level ( n=14) or avoidance of surgery (n=5). According to univariate analysis, tumor size > 30 mm and pathological type of squamous cell carcinoma were independent predictive factors ( OR 3.13, 95% CI: 1.06-9.21, P=0.038; OR 4.68, 95% CI: 1.02-21.58, P=0.048). The diagnostic sensitivity of NBI group was 88.2%, specificity 83.3%, positive predictive value 98.1% and false predictive value 41.7%. And the diagnostic sensitivity of WLB group was 80.3%, specificity 55.6%, positive predictive value 94.7% and false predictive value 22.2%.

The combined use of NBI bronchoscopy and conventional white-light examination has greater sensitivity and specificity for assessing tumor margins. And this technique also significantly improves theassessment of central lung cancer infiltration and influences the therapeutic strategy.

To explore the efficacies of treating patients with large area third-degree burns by tangential excision and skin grafting for subcutaneous tissue wounds.

From January 2002 to December 2013, the medical records were retrospectively reviewed for 31 consecutive adult patients with a third-degree burn area exceeding 70% and undergoing tangential excision and skin grafting on subcutaneous tissue wound (TESGSTW) for the first time within 7 days postburn at Burn Center, Affiliated Jinan Central Hospital, Shandong University. For 31 patients, wounds with relative integrity eschar underwent TESGSTW by stages. Tourniquet was not used in some extremities. The relevant clinical data including patient condition on admission, causes of death, blood loss of tangential excision wound, surgical procedures and efficacies in cured group were analyzed.

Average age, burn total area and third-degree burn area of 31 patients were (32.4±12.8) years, (89.0±6.2)% and (80.4±7.6)% respectively. There were inhalation injury (n=25, 80.6%) and early-stage shock before hospitalization (n=22, 71.0%). Among 18 cured ones (58.1%), 2 patients had a third-degree burn area ≥90%. And 13 patients (41.9%) died and 10 of them died at 4 to 19 days postburn. Burn area was a risk factor of burn mortality. Sepsis and multiple organ dysfunction syndrome (MODS) were major mortality causes. Four patients died from early-stage sepsis. Within 14 days postburn, average blood loss volume per 1% tangential excision area in non-tourniquet group was slightly higher than that in the tourniquet group, but the difference was insignificant. For 18 cured patients, TESGSTW were performed 41 times. For 14 patients (77.8%), TESGSTW was performed twice. The average time of the first tangential excision was (4.1±0.6) days postburn, the time interval between the first two tangential excisions was (6.4±2.0) days, the first tangential excision area (33.8±7.6)% and accumulated tangential excision area (58.4±10.8)%. Among 39 operations within 14 days postburn, refrigerated allogeneic or fresh porcine skin grafts were involved 33 times (84.6%). The wounds were fresh and bleeding after peeling 5 to 7 days postoperation. The time of allogeneic (xenogeneic) skin removal or rejection, recipient bed debridement and auto-skin grafting was (18.0±4.8) days postoperation. And the auto-skin survival rate was (89.5±9.5)%. Wound infection occurred 5 times in 4 patients. During a follow-up period of 6-108 months after TESGSTW, healed wound surface was plump and contraction relatively mild and non-prone to ulceration. And both extensibility and sensitivity were good.

TESGSTW is safe for treating patients with large area third-degree burns. And its short and long-termoutcomes are favorable.

To explore the factors associated with glycemic control in adults with type 1 diabetes mellitus (T1D) on an insulin pump.

A total of 108 patients aged over 18 years and on an insulin pump therapy for >6 months were selected from 16 centers of Guangdong Type 1 diabetes Translational Medicine Study. They were classified into two groups according to the (American Diabetes Association) ADA Hemoglobin A1c target (7.0%). Those reaching the target ( n=59) were compared with those failed (n=49) using ANOVA and Logistic regression.

There were 75 females and 33 males with a median age of 32.0 (25.9-40.9) years and a median disease duration of 7.9(4.2-12.3) years. Logistic regression analysis revealed an odds ratio of 4.48(95%CI 1.53-13.15, P=0.00) for total daily basal insulin dose within 0.2-0.3 units per kilogram, an OR of 1.31 (95%CI 1.05-1.63, P=0.01) for self-monitoring of blood glucose (SMBG) and an OR of 3.43 (95%CI 1.18-10.01, P=0.02) for males.

Higher frequencies of SMBG and appropriate basal insulin dose are essential for adult patients withT1D on an insulin pump.

To explore the association between serum inflammation levels and cognitive function in patients with obstructive sleep apnea-hypopnea syndromes (OSAHS) and evaluate the effects of continuous positive airway pressure treatment (CPAP) on serum inflammation levels and cognitive function.

A total of 139 eligible patients were monitored by overnight polysomnography (PSG) at Sleep Center, Second Affiliated Hospital, Soochow University from June 2011 to April 2013. Based on the results of apnea-hypopnea index (AHI), they were divided into 4 groups of primary snoring (n=18), mild OSAHS(n=23), moderate OSAHS (n=29) and severe OSAHS (n=69). The questionnaires of Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) and Epworth Sleepiness Scale (ESS) were administered to assess cognitive function and daytime sleepiness. The serum levels of high-sensitivity C-reactive protein (Hs-CRP), leptin and tumor necrosis factor alpha (TNF-α) were detected to evaluate systemic inflammation. The questionnaire scores, serum levels of Hs-CRP, leptin and TNF-α and PSG parameters were compared among 4 groups. Thirty-three patients in severe OSAHS group (treatment group) with good adherence were evaluated at baseline and after long-time CPAP treatment.

Compared to primary snoring group, the serum Hs-CRP ((1.77±1.19) vs (0.92±0.82) mg/L), leptin ((15.21±13.26) vs (6.35±4.51) mmol/L) and TNF-α ((21.04±7.78) vs (10.30±5.23) pmol/L) levels increased significantly in severe OSAHS group (P<0.05). After adjusting for body mass index (BMI), age and education years, MoCA scores showed negative correlations with serum TNF-α, AHI, oxygen reduction index (ODI) and TS90% (r=-0.266, -0.236, -0.201, -0.18 respectively, all P<0.05) and positive correlations with minimum oxygen saturation (LSaO₂)(r=0.224, P<0.05). The evaluations of MoCA subdomains further revealed selective reductions in visual space, executive function, attention and delayed memory function. The treatment group with good adherence to > 6-month continuous positive airway pressure (CPAP) treatment and after CPAP treatment, the serum levels of Hs-CRP, TNF-α and leptin improved markedly ((1.20±0.88) vs (2.03±1.58) mg/L, (14.12±4.34) vs (22.74±6.72) pmol/L and (7.37±5.30) vs (13.69±7.17) mmol/L respectively). The scores of MoCA and ESS also improved (27.79±1.69 vs 24.76±2.57, 4.33±3.14 vs 12.61±5.80 respectively) (allP<0.01). The score of all MoCA subdomains improved after treatment.

Cognitive dysfunction and inflammatory reaction are common in OSAHS patients. MoCA scores are correlated significantly with serum level of TNF-α and nocturnal intermittent hypoxia. Systemic inflammation may play an important role in cognitive dysfunction of OSAHS patients. And long-time CPAPtreatment can improve systemic inflammatory response and cognitive impairment.

To investigate the effect of dexmedetomidine pretreatment on hypoxia/reoxygenation-induced injury in human umbilical vein endothelial cells and the possible mechanism.

Cultured human umbilical vein endothelial cell-12(HUVEC-12)were randomly divided into four groups(n=24): group control (C), group dexmedetomidine (D), group hypoxia/reoxygenation (H/R), group hypoxia/reoxygenation plus dexmedetomidine (H/R+ D). In groups D and H/R+ D, Dexmedetomidine 50 μmol/L was added to the culture medium and the cells were incubated for 2 h. Then groups C and D were exposed to regular incubator and incubated for 12 h, groups H/R and H/R+ D were incubated in an anaerobic chamber for 6 h and then returned to a regular incubator and incubated for 6 h. Cell growth conditions were observed under inverted microscope, the cell viability and apoptosis were measured by methyl thiazolyl tetrazolium (MTT) assay and flow cytometry respectively.Reverse transcriptase polymerase chain reaction (RT-PCR) was used to detect the expression of CHOP mRNA. Western blotting was used to detect the expression of CHOP and cleaved caspase-3 protein.

Compared with group C, the cell survival rate was significantly decreased, the expression of CHOP mRNA and CHOP protein, cleaved caspase-3 protein were up-regulated, the apoptotic rate was significantly increased in group H/R and group H/R+ D(P<0.05), No significant difference was found in group D(P>0.05); compared with group H/R, the cell survival rate was significantly increased, the expression of CHOP mRNA and CHOP protein, cleaved caspase-3 protein were down-regulated, the apoptotic rate was decreased significantly in the group H/R+ D(P<0.05).

Dexmedetomidine pretreatment can effectively attenuate hypoxia/reoxygenation-induced apoptosis to human umbilical vein endothelial cell-12. The mechanism maybe related with down-regulating theexpression of CHOP.

To explore the effects and underlying mechanisms of ursodeoxycholic acid on human hepatoma cells.

HepG2 and SMMC-7721 HCC cell lines were respectively treated with ursodeoxycholic acid. And cell proliferation, apoptosis and the expression of Bax/Bcl-2 gene were detected by methyl thiazolyl tetrazolium (MTT), inverted microscopy, fluorescent microscopy, flow cytometry and Western blot.

Ursodeoxycholic acid significantly inhibited the proliferation of human hepatoma cells in a concentration- and time-dependent manner. The half maximal inhibitory concentrations (IC50) of HepG2 and SMMC-7721 were 397.3 and 387.7 μg/ml respectively after a 48-hour treatment of 400 μg /ml ursodeoxycholic acid. And it also induced the apoptosis of HepG2 and SMMC-7721 cells, up-regulated Bax gene and down-regulated Bcl-2 gene.

Ursodeoxycholic acid inhibits the proliferation of hepatoma cells and induce apoptosis bymitochondrial-mediated pathway.

Since 2012, a novel coronavirus infection has emerged in the Middle East region, which has now been named Middle East respiratory syndrome coronavirus (MERS – CoV), which is the sixth coronavirus found to infect humans and belongs to the C-line beta coronavirus^[1]。 The virus can cause symptoms similar to those of severe acute respiratory syndrome (SARS), with patients ranging from asymptomatic to severe pneumonia with acute respiratory distress syndrome and multiple organ failure. All patients with symptoms have respiratory symptoms, and another 1/3 of patients have gastrointestinal symptoms^[2]。 As of 23 July 2014, there were 837 laboratory-confirmed cases, including 291 deaths, involving 21 countries in the Middle East, Europe, Africa, North America and Asia. Although there are no imported cases in China at present, because MERS-CoV infection often leads to serious diseases, the mortality rate is higher than that of SARS, and a large number of people travel between China and the Middle East every year due to travel and Hajj, it still deserves clinical vigilance and attention. From March to April, 2014, a large number of medical staff infections in the Middle East sounded the alarm for disease prevention and control. Therefore, the latest progress and implications of MERS research are summarized as follows.

Patient, male, 71 years old. He was admitted to hospital on October 29, 2012 due to cough, sputum, chills and fever for 2 days. Before the illness, he had a history of cold, yellow phlegm, and the highest body temperature was 38 ℃, accompanied by shortness of breath and persistent right chest swelling and pain. Admission physical examination: A little wet rales was smelled in the right lung. Blood routine: white blood cells 25.13×10⁹/L, neutrophils 92.1%, platelets 74×10⁹/L, hemoglobin 143 g/L. Blood sodium 130 mmol/L, potassium 3.0 mmol/L, chlorine 97 mmol/L; Blood myocardial enzymes and troponin T were normal. Arterial blood gas analysis (without oxygen): pH 7.54, PaO₂76 mmHg (1 mmHg =0.133 kPa), PaCO₂25 mmHg, Oxygen saturation 96.2%. Electrocardiogram showed atrial fibrillation. Liver function was normal. Total blood protein was 63.1 g/L, albumin was 36.7 g/L, white globule ratio was 1.4, total bilirubin was 42.5 μ mol/L, and direct bilirubin was 12.4 μ mol/L. Blood glucose 7.24 mmol/L. Procalcitonin 5.37 μ g/L. Chest CT at admission: large ground glass shadow in the middle lobe of the right lung, thickening of the right pleura (Figure 1) Cardiac color Doppler ultrasound showed a small amount of tricuspid regurgitation and normal left ventricular systolic function. Venous color ultrasound of both lower limbs: no obvious abnormality.

The 63-year-old female was seen on November 14, 2013 10 days later because the liver occupied space was found by B-ultrasound during health examination. He was in good health and had no symptoms such as abdominal pain, distension, fever, nausea, vomiting and yellowing of the skin and sclera. No obvious abnormal signs were found on physical examination, and no obvious abnormalities were found in blood routine, biochemistry, hepatitis B, coagulation spectrum and complete set of tumors after admission. CT showed that a 33 mm ×25 mm ×28 mm occupied space was seen in the VI segment of the right liver; MRI showed that the parenchyma of the right liver segment VI mass showed a slightly high signal on T2WI and DWI, a low signal on the same phase of T1WI, and an isosignal on the opposite phase; The parenchyma of the arterial mass began to strengthen in the early stage of enhancement scan, significantly strengthened in the late stage, and continued to strengthen in the delayed stage of portal vein. On November 19th, liver tumor resection was performed under general anesthesia. Intraoperatively, a 40 mm ×30 mm nodule was seen in segment VI of the liver near the liver capsule, which was slightly hard in texture and had no adhesion to the surrounding tissues. Intraoperative rapid freezing pathological diagnosis predisposes to benign bile duct adenomas. Gross examination: The partial liver resection specimen showed a nodule with a size of 25 mm ×20 mm ×10 mm. The section surface was pale yellow and medium, and the boundary with the surrounding liver tissue was clear. HE morphological characteristics: The tumor is composed of mature, benign-appearing small bile ducts, with a relatively clear boundary with the surrounding normal liver tissues. It is densely proliferated by the surrounding small bile ducts, with a round lumen, a diameter close to the interlobular bile ducts, and chronic inflammatory cell infiltration can be seen in the interstitium (FIG. 1A)； The interstitial fibrous tissue near the central region proliferates and collagenizes, and the density of the small bile duct decreases. It is separated by fibrous tissue and squeezed into a fissure or irregular shape (FIG. 1B), and even the small bile duct disappears where collagenization is obvious; The bile duct cells were dwarf cubic, the nucleus was round, the cell morphology was mild, no atypia, mitotic image and necrosis were observed; There was no obvious dilated cystic bile duct in the tumor, and there was no bile in the bile duct. Immunohistochemistry showed that CK19, CK7, CD56 and CD10 were all (+), while AFP, P53, CDX2, CK20, TTF-1 and Syn were all (-); The proliferation index of Ki – 67 was 5%. Pathological diagnosis: (right liver) intrahepatic bile duct adenoma (BDA). No treatment was given postoperatively. Follow-up for 6 months showed good condition and no tumor recurrence was observed.