As a necessary diagnostic criteria for acute myocardial infarction ,the sensitivity of cardiac troponin is of great significance in clinical diagnosis and treatment .Commercial kits also experienced several generations , and gradually entered the era of high sensitivity . High sensitivity era has brought us opportunities and challenges , the higher sensitivity greatly promotes the efficiency of early diagnosis , highlights the risk assessment and prognostic value , but it also leads to the reduction of diagnostic specificity, we must understand the application features so we can meet the challenges better .In this article we elaborated the application value of high-sensitivity troponin and some matters needing attention .

Objective To analyze the relation between glycosylated hemoglobin (HbA1c) and coronary heart disease (CHD) among diabetic and non-diabetic individuals.Methods A total of 1190 in patients from January 2009 to September 2009 were selected and divided into two groups:225 patients with diabete mellitus and 965 patients without.We collected the age,sex,triglyceride ( TG),total cholesterol ( CHO),high-density lipoprotein ( HDL-C),low-density lipoprotein ( LDL-C),fasting blood-glucose (FBG),glycosylated hemoglobin (HbA1c),high-sensitivity CRP (hs-CRP) and analyzed the relation between these indexes and CHD in diabetic and non-diabetic individuals respectively,then,analyzed the difference of HbA1c between patients with and without CHD after correcting the differentiating factor with a multivariable-adjusted model.Meanwhile,according the HbA1c level,we divided all participants into four groups:4.0％ -5.4％( Ⅰ),5.5％ -5.9％ ( Ⅱ),6.0％ -6.4％ ( Ⅲ),≥6.5％ ( Ⅳ),and observed the distribution of HbA1c and coronary heart disease in diabetic and non-diabetic individuals respectively.Results ( 1) In non-diabetic individuals,statistically significant difference of male( 80.5％ υs 62.7％),age [ ( 59 ±11) years υs (55 ± 11) years],FBG [(5.62 ± 1.48) mmol/L υs (5.30 ±0.84) mmol/L],HbA1c [(5.98±0.92)％ υs (5.65 ±0.53)％],CHO [(4.48 ±1.01) mmol/L υs (4.77 ±1.04) mmol/L],LDL-C [(2.59±0.87) mmol/L υs (2.79 ±0.86) mmol/L],HDL-C [(1.08 ±0.26) mmol/L υs(1.21 ±0.32) mmol/L] was observed between patients with and without CHD (P ＜0.01),however,in diabetic individuals,only LDL-C [ ( 2.56 ± 0.81) mmol/L υs ( 3.07 ± 0.90) mmol/L],CHO [ (4.44 ±0.95) mmol/L υs ( 5.08 ± 1.16) mmol/L] were observed ( P ＜ 0.0 1).(2) In all participants,the higher of HbA1c,the higher of CHD percent,compared to patients without CHD,the percent of high HbA1c in CHD patients was significantly higher.After adjusting for age,sex,HDL-C,HbA1c was an independent risk marker for CHD in non-diabetic individuals ( OR:1.935,95％ CI:1.356 - 2.762,P ＜ 0.05),however,links between FBG in the non-diabetic range and CHD appeared weaker after controlling indexes listed above( OR:1.507,95％CI:1.082 -2.098,P＜0.05).Conclusion HbA1c is an independent risk factor for CHD in nondiabetic individuals and prior to FBG.

Objective To investigate plasma levels of high-sensitivity C-reactive protein (hs-CRP) in patients with coronary heart disease (CHD) and relationship between hs-CRP levels and cardiac function. Methods The serum hs-CRP concentrations in 894 CHD patients diagnosed by coronary angiography and 141 healthy controls were measured by particle enhanced immunoturbidimetric assay. Results The median of hs-CRP levels was 1.70 (0.13-19.53 ) mg/L and abnormal ratio was 37.6% (336/894), that were significantly higher in CHD group than healthy controls [0. 99(0. 13-19. 53) rag/L, 7. 1% (10/141) ] (Z=-6. 476,X<'2> = 50. 882, P <0.01 ). The median of hs-CRP levels was 5.35 (0. 18-19. 10) mg/L and abnormal ratio was 63.9% (92/144), that were much higher in acute myocardial infarction (AMI) group than in old myocardial infarction (OMI) group [2.27 (0.13-19.19) mg/L, 43.7% (129/295) ] (Z = -3.353 ,X<'2> = 15. 732, P <0. 01 ). The median of hs-CRP levels was 1.45 (0.19-19.53) mg/L in unstable angina pectoris(UAP) group and abnormal ratio was 29.1% (73/251), that were was higher in stable angina pectoris (SAP) group [1.04 (0.13-16.31 ) mg/L, 20. 6% (42/204) ] (Z=-2.981, P = 0.003;X<'2> = 4.30, P=0.038 ) . Furthermore, Kruskal-Wallis test showed the concentrations of hs-CRP and NT-proBNP was increased along with increment of CHD severity (NYHA functional classification) (X<'2> = 120.185,424.945, P <0.001 ). Multivariate analysis showed that hs-CRP levels positively correlated with NYHA functional classification ( r = 0.328, P <0.01 ) as well as NT-proBNP levels (r=0.413, P <0.01 ). Conclusion Serum hs-CRP level increases along with CHD severity, indicating that hs-CRP may play a certain role in the occurrence and development of CHD.

Objective To study the effect of MRCP for operation difficulty assessment before laparoscopic cholecystectomy. Methods 110 patients with gallbladder stone were randomly selected from March 2011 to July 2012 in our hospital,and all the patients were given LC operation after examined by MRCP. Regarded the average operation time 30 min as a criterion,when the operation time was no more than 30 min,the operation was considered as normal operation;when the operation time was more than 30 min, the operation was considered as op-eration of a certain degree of difficulty. Made a correlation analysis between LC operation difficulty and age,gender,location,volume of gall-bladder,angle of ductus cysticus, thickness of gallbladder wall, circumstances surrounding the cystic duct, length of ductus cysticus, and whether there were calculus in the cervical part of gallbladder. Results The difficulty level of LC operation is related to length of ductus cys-ticus and whether there were calculus in the cervical part of gallbladder,and there is no correlation with age,gender,location,volume of gall-bladder,angle of ductus cysticus,thickness of gallbladder wall,circumstances surrounding the cystic duct. Conclusion Routinely MRCP test in preoperative patients is of important significance to the prediction of LC operation difficulty.

Objective: To evaluate chemiluminescence immunoassay (CLIA) for detecting blood levels of aldosterone and rennin with its diagnostic value of primary aldosteronism (PA) with comparison to radio immunoassay (RIA). Methods: According to American protocols of CLSI, we conducted a veriifcation study between RIA and CLIA for their precision, accuracy, linearity and reference ranges; meanwhile, taking clinical diagnosis as golden standard, examined renin activity or concentration and aldosterone concentration in 20 healthy volunteers and 40 hypertension patients by both RIA and CLIA, compared the ratios of ARR (aldosterone concentration/renin activity) or ADRR (aldosterone concentration/renin concentration) for the speciifcity and sensitivity of PA diagnosis. Results: Within-lot and between-lot accuracies of CLIA for detecting aldosterone levels were below 5% and 10%, the recoveries were 102% and 95% respectively. There was a good linear correlation in the range of aldosterone at (3-74) ng/dl and renin at (0.99-330) μIU/ml. In healthy volunteers, renin level was higher in 2 subjects, while aldosterone level and ADRR ratio were within normal references in all subjects by the manufacturer. In hypertension patients, the sensitivity and speciifcity for aldosterone and rennin detections by CLIA were at 85.7% and 97.0%, by RIA were at 85.7% and 94.0%. Conclusion: CLIA has the superiority of simple performance, repeatable and without radioactive contamination; it is recommended for replacing RIA as necessity.

Objective To evaluate the utility of MMP9,MPO and sCD40L in detection of the character of coronary artery plaque.Methods From April 2008 to January 2010,118 patients from outpatient of Fu Wai Hospital with chest pain were enrolled.All of them underwent 64 Multiple-detector row spiral computer tomography (64-MDCT),the CT value ＜ 130 Hu patients were enrolled in non-calcified plaque group (71 cases),CT value ≥ 130 Hu patients were enrolled in the calcified plaque group (47 cases).Ninty healthy volunteers were selected as the control group.Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum markers,including MMP9,MPO and sCD40L.Levels of MMP9,MPO and sCD40L of each group were compared.ROC curve was used to evaluate the sensitivity and specificity of the markers in diagnosis of non-calcified plaque.Results MMP9,MPO and sCD40L levels of non-calcified were ( 762.25 ± 368.71 ),[ 844.10 (582.00 - 1220.70) ],(9.37 ± 3.15) μg/L,higher than the healthy control group (342.70 ± 178.53),[426.35 ( 283.20 - 592.00) ],(6.55 ± 2.96) μg/L and calcified plaque group ( 483.12 ± 219.09 ),[ 469.00 ( 302.45 - 723.55) ],( 7.24 ± 2.86) μg/L The difference was statistically significant ( F =42.47,H =50.28,F =17.94,all P ＜ 0.01 ). Areas of MMP9,MPO and sCD40L under the ROC curve to predict non-calcified plaque were 0.854,0.792,0.751 respectively,when the identification threshold for non-calcified plaque were 510.13,537.82,7.05 μg/L respectively,the diagnostic sensitivity was 80％,80％,80％ respectively,and specificity was 80％,67％ and 55％ respectively.Conclusion The serum MMP9,MPO and sCD40L levels can help to determine the　character of coronary plaque.

Objective:To explore the mechanism of Mito-TEMPO inhibiting the activation of BV2 microglia induced by lead(Pb)exposure.Methods:Mouse microglia BV2 were cultured in vitro.The effects of different concentrations of lead exposure on the viability of BV2 cells were determined by MTT colorimetric method,and a model of lead expo-sure was developed and intervened with Mito-TEMPO antioxidant.Immunofluorescence staining was used to detect the expression of M1 activation marker CD86 protein.Enzyme-linked immunosorbent assay was used to detect the expression of pro-inflammatory factors interleukin-1 β(IL-1β),tumor necrosis factor α(TNF-α),interleukin-6(IL-6).Mito-chondrial superoxide indicator(MitoSOX)staining was used to detect the level of mitochondrial oxidative stress.JC-1 staining was used to detect mitochondrial membrane potential.The respiratory ability of mitochondria was detected by cell energy metabolism analysis system(O2k).Results:Compared with the control group,the expression of CD86 protein,the levels of pro-inflammatory cytokines IL-1β,TNF-α and IL-6 in BV2 cells increased significantly,the level of oxidative stress in mitochondria increased significantly,and the mitochondrial membrane potential and respiratory ability decreased significantly in lead exposed group.Mito-TEMPO treatment significantly reduced the oxidative stress and functional damage of mitochondria in BV2 cells,and significantly inhibited the M1 activation level of BV2 cells.Conclusion:The results show that Mito-TEMPO treatment can reverse the M1 activation of BV2 cells induced by lead exposure,and the specific mechanism may be related to the reduction of mitochondrial oxidative stress and dysfunction by Mito-TEMPO.