Objeclive To investigate the relationship between carotid atheroselemtic(CAS)plaque and homocysteine(HCY),C-reactive protein(CRP)and ischemie eerebrovasclar desease(ICVD).Methods 468 patients with ICVD and 456 patients without eerebrovaseular disease(control group)were detected by carotid color duplex in IMI,number,size and character of carotid atherosclerosis(CAS) plaque and thelevels of HCY and CRP were evaluated,and compared with normal control group.Results(1)Compare with control group,the IMT,prevalence of CAS plaque,the rates of soft plaque in ICVD group were significantly higher(all P＜0.05).(2)The levels of HCY and CRP in ICVD were significantly higher than those in control group(P＜0.05),and in ICVD with plaque subgroup were significantly higher than those in ICVD without plaque subgroup(P＜0.05).(3)The prevalence of CAS plaque and IMT were positively correlated with the levels of HCY and CRP(r=0.32,0.30 repectively,P＜0.05).Condusion ICVD patients show increased IMT and hJish prevalence of CAS plaque.CAS plaque and hyperhomocystoinemia is an independent risk factor for ICVD.The level of CRP is an important biological marker to evaluate the severity and prognosis of ICVD.

Objective To explore the changes and the clinical signficance in serum myocardial zymogram of patients with intracerebral be hemorrhage(ICH).Methods To estimate the serum myocardial zymogram.Serum aspartate aminotrasferase(AST),lactate dehychogenase (LDH),creatine kinas (CK) in patients with ICH were measured in 3 days,then to make comparison with control group.Results The serum myocardial zymogram in ICH group were higher than that of control group(P <0.05).There were different changes in serum myocardial zymogram of various parts.The serum myocardial zymogram in group with temporal lobe damage was higher than that of group without temporal lobe damage (P < 0.05).The serum myocardial zymogram of group with colliculus brain damage was higher than that of group without colliculus brain damage(P <0.05) ,the serum myocardial zymogram of group with disorder of consciousness was higher than that of group wakefulness(P < 0.05).Conclusion There are significant changes in the serum myocardial zymogram of patients with ICH.The incidence of the serum myocardial zymogram in ICH was close]y correlated to the severity area and part of ICH,consciousness disorder.To estimate serum zymogram is helpful to judge patients' state and prognosis.

0.05).The degree of angiostegnosis:1-grade stenosis in MSCTA was higher than that in DSA.The 2-grade,3-grade and 4-grade stenosis in DSA were higher than that in MSCTA(all P

Objective To investigate the relationship between the expression ofα1-antichymot-rypsin (α1-ACT)in plasma and postoperative cognitive dysfunction(POCD).Methods The cognitive function of 64 patients undergoing operation under general anesthesia was evaluated by a battery of cognitive assessment instruments(BCAI)and the levels ofα1-ACT were measured at the time 1 d pre-operatively and 7 d and 3 months postoperatively.The patients were randomly divided into two groups:30 patients in ulinastatin group (group U)were injected with 10 000 U/kg ulinastatin,which was dissolved in 100 ml saline,within 20 min at the time of 30 minutes before induction;while control group (group C)were injected with the same volume saline.Results There was no significant differ-ence between the expression of α1-antichymotrypsin in patients with POCD and in control patients at the time before operation.Compared with control patients,the levels of α1-ACT in patients with POCD at the time of 7 d and 3 months postoperation were significantly higher (P <0.05).The levels of α1-ACT at 7 d postoperation were significantly higher than that preoperatively in both groups (P <0.05).The incidence of POCD in group U were significantly lower than that in group C,at the time of 7 d and 3 months after surgery (P <0.05).Conclusion POCD is associated with high expression of plasma α1-ACT.

Objective To explore the risk factors of the recurrence of ischemic stroke and to supply theoretical basis for secondary prevention.Methods 612 patients with ischemic stroke were enrolled in the study and they were followed-up for 2 years to record the stroke recurrence.According to whether the recurrent stroke occurred,all the patients were divided into the recurrent group and the non-recurrent group.Logistic regression model was used to analyze the risk factors.Results Of 612 patients,90 patients suffered from recurrent stroke and the recurrence rate after 2 years was 14.7％.In the recurrent group,age,smoking,hypertension,diabetes,fibrillation atrial history and homocysteine level were significantly higher than those in non-recurrent group (P ＜ 0.05),compliance of anti-platelet drugs was significantly lower than that in non-recurrent group (P ＜ 0.01).Multivariate analysis suggested that age,smoking,hypertension,diabetes,atrial fibrillation history,homocysteine level and compliance of anti-platelet drugs were associated with recurrence of ischemic stroke (OR value =11.14,47.38,53.11,111.12,53.11,40.98,90.12,all P ＜ 0.05).Conclusion Age,smoking,hypertension,diabetes,atrial fibrillation history,homocysteine level and compliance of anti-platelet drugs are the independent risk factors of recurrent stroke.To enhance the interference of these risk factors are helpful for preventing the recurrence of stroke.

Objective To investigate the correlation of the plasma homocysteine level and serum B/apolipoprolionAl(ApoB/ApoAl) radio with cerebral vascular stenosis in patients with cerebral infarction.Methods 184 patients with cerebral infarction experienced cerebral digital substraction angiography (DSA) were selected.Among them,158 patients with cerebrovascular stenesis and 26 patients without stenosis were included.Three groups were categorized by distribution of artery lesion sites:isolated intracranial artery stenesis ( n =48 ),isolated extracranial artery stenosis( n =60) co-existing of intracranial and extracranial artery stenosis( n =50).The correlation analysis was made between the levels of Hcy and ApoB/ApoAl with cerebral vascular stenosis in patients with cerebral infarction.Results ( 1 ) The proportion of subjects with high level of plasma homocysteine was significantly higher in patients with cerebrovascular stenosis than those without[( 16.9 ±8.1 ) μmol/L vs (8.6 ±4.6) μmol/L,P ＜0.001 ;40％ vs 0,P ＜0.01].The proportion of subjects with high level of ApoB and ApoB/ApoA1 ratio was significantly higher in patients with cerebrovascular stenosis than those without ApoB [( 1.02 ± 0.25 ) vs ( 0.86 ± 0.22 ) g/L,P ＜ 0.01],ApoB/ApoAl ratio [( 0.94 ± 0.50) vs ( 0.64 ± 0.21,P ＜ 0.01 )].(2) For the different groups of artery lesion sites,the proportion of subjects with high level of plasma homocysteine was not significantly different[( 16.1 ± 8.5 )mml/L、( 17.0 ± 8.9 ) mmol/L、( 16.7 ± 8.7 ) mmol/L,P ＞ 0.05],the proportion of subjects with ApoB/ApoAl ratio was not significantly different [0.98 ± 0.45,0.93 ± 0.48,0.96 + 0.50,P ＞ 0.05].(3) Based on multivariable stepwise Logistic regression model,the increased level of Hcy( OR =1.146,95％ CI:1.021 ～ 1.287 ;P =0.021 ),the increased level of ApoB/ApoAl ( OR =4.71,95 ％ CI:1.70 ～ 14.20,P =0.005 ),the increased level of ApoB ( OR =4.50,95 ％ CI 为 1.62 ～ 12.80,P =0.007),the increased level of Cho ( OR =2.406 ;95％ CI:1.145 ～ 5.055 ; P =0.023 ),the decresed level of HDL( OR =0.089,95％ CI:0.014 ～ 0.551,P =0.017 ) were all risk factors.Conclusion High level of plasma homocysteine and ApoB/ApoAl were both independent risk factors for cerebral vascular stenosis.

Objective To study the variation of acute blood pressure in different subtypes of first ischemic stroke,and investigate the influence on the prognosis.Methods A total of 710 patients with first ischemic stroke were selected.The blood pressure levels were monitored during the initial 7 hospital days.Clinical outcome was based on the combined analysis of Barthel index and the National Institute of Health Stroke Scale (NIHSS) score on the 180th day.In the subtypes of large artery atherothrombosis(LAA),cardioembolism (CE),small artery disease occlusion (SAO) were 400,160,150 cases.Logistic regression model was used to estimate the influencing factors on the prognosis.Results An U-shaped effect was observed in different subtypes between blood pressure on admission,average acute blood pressure and prognosis.In the subtypes of LAA and CE,those who had a basehne systolic blood pressure (SBP) of 140-159 mm Hg (1 mm Hg =0.133 kPa) or a baseline diastolic blood pressure (DBP) of 90-99 mm Hg on admission got good prognosis.In the subtypes of SAO,those who had a baseline blood pressure of 130/95 mm Hg on admission got good prognosis.In all subtypes,the average blood pressure of 150/95 mm Hg got good prognosis.In the subtypes of LAA and CE,those who had a baseline SBP of 120-159 mm Hg or a baseline DBP of 80-99 mm Hg within 7 d after admission got good prognosis.In the subtypes of SAO,those who had a baseline blood pressure of 140/90 mm Hg within 7 d after admission got good prognosis.In all subtypes,the average blood pressure of 140/90 mm Hg within 7 d after admission got good prognosis.Logistic regression analysis revealed that the decrease of blood pressure during the first 24 hours,deterioration within 7 d after admission,acute complication,NIHSS score on admission were the independent risk factors of prognosis,while antihypertensive therapy in the acute phase was the independent protection factor in the subtypes of LAA and CE.In the subtypes of SAO,acute complication was the independent risk factor of prognosis.Conclusions An U-shaped effect is observed in different subtypes between blood pressure on admission and prognosis.In the subtypes of LAA and CE,the decrease of blood pressure during the first 24 hours,deterioration within 7 d after admission,acute complication,NIHSS score on admission are the independent risk factors of prognosis.

Objective To evaluate dendritic cell vaccine immunotherapy in postoperative colorectal cancer patients. Methods 40 colorectal cancer patients were divided into two groups. Group A was not treated with the dendritic cell vaccine after chemotherapy, Group B was treated with four courses of autologous dendritic cell vaccine. The level of cytokines was tested before and after the therapy in both groups. DTH were tested after the last course of treatment. Results The levels of cytokines significantly increased in group B after vaccination compared with that in group B before vaccination and that in group A.8 patients were DTH positive in 15 patients that were tested after the vaccination. The PTS (progression-free survival) was 22 months in group B compared with 17 months in group A. The recurrence of the disease was not observed in patients with DTH positive. Conclusion DC vaccine in postoperative colorectal cancer patients improves the immune status and elicits tumor-specific response.

Objective To investigate the molecular characteristic,the virulence factors and antimicrobial resistance of Methicillin-resistant Staphylococcus aureus (MRSA) isolated from pediatric patients.Methods Ninety-eight non-duplicate strains of and 49 non-duplicate strains of Methicillinsusceptible Staphylococcus aureus (MSSA) isolated from the three children's hospitals in Shanghai in 2008 were investigated.Panton-valentine leukocidin (PVL) gene was detected by polymerase chain reaction (PCR).The genotypes of staphylococcal cassette chromosome mec (SCCmec) of the MRSA isolates were confirmed by multiplex PCR.The sequence type (ST) of each strain was determined by multilocus sequence typing (MLST),and the algorithm eBURST was used to identify groups of clonal complex (CC).The minimal inhibitory concentrations (MIC) of fourteen antibiotics for all isolates were determined by agar dilution method.Results Among 98 isolates of MRSA,the positive rate of PVL genes was 6.1％ (6/98).In contrast,the positive rate of PVL genes was 4.1％ (2/48) of the MSSA strains.Among 98 isolates of MRSA,4.1％ (4/98),23.5％ (23/98),53.0％ (52/98) and 15.3％ (15/98) of the strains harboured SCCmec types Ⅱ,Ⅲ,Ⅳ and Ⅴ,respectively. The remaining four isolates (4.1 ％) presented a unique SCCmec pattern that could not be classified to any known types by the employed typing assays.Combining the ST and SCCmec type,the predominant clones were ST59-SCCmec Ⅳ (30 strains) and ST239-SCCmec Ⅲ (23 strains),followed by ST5-SCCmecⅣ and ST1-SCCmecⅣ (8 strains for each clone),ST239-SCCmec Ⅴ (6 strains),ST88-SCCmecⅤ (5 strains),ST5 SCCmecⅡ (4 strains),ST59-SCCmec Ⅴ (3 strains),ST8-SCCmecⅣ and ST88-SCCmecⅣ (2 strains for each clone),ST22-SCCmecⅣ,ST910-SCCmecⅣ and S45-SCCmec Ⅴ (1 strain for each clone),eBURST analysis distributed the MRSA isolates into several CC.ST8 and ST239 belonged to ST8 CC,ST1 belonged to ST15 CC,ST910 belonged to ST 30 CC,ST59,ST5,ST88,ST45,ST22,ST9 and ST7 were the origin of their own CC.The results of MIC showed that the 67 strains of MRSA harboring SCCmec type Ⅳ or SCCmec type Ⅴ were more susceptible to various non-β-lactam antibiotics than 27 strains of MRSA harboring SCCmec type Ⅱ or SCCmec type Ⅲ,and no vancomycin-resistant strain was found.Conclusions In three children's hospitals in Shanghai,the PVL gene-positive rate of MRSA isolates is relatively low,SCCmec type Ⅳ and SCCmec type Ⅴ could spread among hospitals to cause a small scale epidemic and have a variety of ST.

The Hedgehog (Hh) signalling pathway is essential for cellular proliferation and differentiation during embryonic development.Gain and loss of function of Hh signalling are known to result in an array of craniofacial malformations.To determine the critical period for Hh pathway antagonist-induced frontal bone hypoplasia,we examined patterns of dysmorphology caused by Hh signalling inhibition.Pregnant mice received a single oral administration of Hh signalling inhibitor GDC-0449 at 100 or 150 mg·kg-1 body weight at preselected time points between embryonic days (E)8.5 and 12.5.The optimal teratogenic concentration of GDC-0449 was determined to be 150 mg·kg-1.Exposure between E9.5 and E10.5 induced frontal bone dysplasia,micrognathia and limb defects,with administration at E10.5 producing the most pronounced effects.This model showed decreased ossification of the frontal bone with downregulation of Hh signalling.The osteoid thickness of the frontal bone was significantly reduced.The amount of neural crest-derived frontal bone primordium was reduced after GDC-0449 exposure owing to a decreased rate of cell proliferation and increased cell death.