Objective To explore the clinical significance of DSA and MRA detection in cerebrovascular desease of patients with diabetes mellitus.Methods 142 diabetic patients were selected in the study. The vascular structure was detected by digital subtraction angiography (DSA) and magnetic resonance angiography (MRA) . Results There was 1123 (56.5%) branches of artery atherosclerotic stenosis in a total of 1988 detecting artery and there was no significant difference between the DSA and MRA (χ2=0.36、0.47、0.53,P>0.05) . The results showed that the DSA and MRA methods had no significant difference on display average count in detecting bilateral ACA,MCA,PCA 284 vessels (t=0.27、0.56、0.89,P>0.05) . There were 656 arteries stenosis in checking the Willis ring vascular by DSA evaluation of the Willis ring and the sensitivity and specificity by MRA were more than 90%. Conclusion MRA and DSA can be applied in diagnosis of in cerebrovascular disease of patients with diabetes mellitus.The noninvasive advantages of MRA are worth to be concerned by clinician.

Objective To investigate predictors of one year mortality in the elderly patients with hip fracture following poststroke hemiplegia.MethodsA retrospective study was conducted to analyze clinical data of the elderly patients who had received surgery in our hospital from January 2000 to May 2007 forhip fractures.Patients in the poststroke hemiplegia group (group A) and the hemiplegia-free group (group B)were compared in terms of general characteristics.Predictors of one year mortality in group A were analyzed statistically.Variables to be analyzed included age,gender,American Society of Anesthesiologists(ASA) rating,preoperative comorbidity,fracture type,prefracture ambulatory status and cognitive ability,hospital stay,interval from injury to surgery,anaesthetic mode and operational mode. Results Altogether 1379 patients with a mean age of 76.4 ± 7.0 years (from 65 to 99 years) were eligible for the present investigation.Of them,101 were assigned into group A.There were significant differences between the 2 groups in ASA rating,number of preoperative comorbidity,prefracture ambulatory status and cognitive ability,hospital stay and one year survival ( P ＜ 0.05).One year follow-up found 25 deaths in group A (mortality rate 24.8％ ).Multiple logistic regression analysis showed that gender ( P =0.017),ASA rating ( P=0.009),prefracture ambulatory status ( P =0.000),chroic respiraory disease ( P =0.022) and number of preoperative comorbidity ( P =0.048) were risk factors associated with the one year mortality in group A.ConclusionsEldarly hip fracture patients with hemiplegia tend to have a longer hospital stay and a higher mortality rate than those without hemiplegia.Male gender,ASA rating ≥ Grade Ⅲ,number of preoperative comorbidity ≥ 3,chronic respiratory disease and weak prefracture ambulatory status are predictors of one year mortality in the elderly patients with hip fracture following poststroke hemiplegia.

Objective To observe the effect of Du-moxibustion on cognitive impairment after stroke. Methods 60 patients with cognitive impairment after stroke were randomly divided into control group (n=30) and treatment group (n=30). They were treated with conventional medical treatment and rehabilitation training, the treatment group received Du-moxibustion treatment in addition with once a day, 6 days per week for 8 weeks. They were evaluated with modified Barthel Index (MBI) and Montreal Cognitive Assessment (MoCA) before and after treatment. Results The scores of MBI and MoCA increased after treatment (P<0.05) in both groups and the scores were higher in the treatment group than in the control group (P<0.05). Conclusion Du-moxibustion can further improve the cognitive function and activities of daily living in stroke patients.

Objective To study the curative effect of prosthetic replacement for femoral neck frac-tures at the hemiplegic extremity in the elderly with previous stroke. Methods From May 1990 to May 2000, 189 elderly patients with femoral neck fractures were treated with prosthetic replacement. 29 cases were of previous stroke with femoral neck fractures (Garden type Ⅲ and type Ⅳ) at hemiplegic extremity. 30 non-hemiplegia cases were adopted randomly as control. Two group patients were subjected to a follow-up study for 2 years and 3 months to 8 years and 2 months(average 4 years and 11 months) to compare the differences of ages, hospitalization days, operation time, blood loss, blood transfusion, complications during perioperative period and short-term complications with each other as well as the results of femoral head re-placement versus total hip replacement in treatment of hemiplegia group. Results Two group patients sur-vived during perioperative period. The ages, hospitalization days, operation time, blood loss and blood trans-fusion were of no significant difference in two groups, while complications during perioperative period were of significant difference. 5 patients died in hemiplegia group and 2 patients died in non-hemiplegia group at 11 months to 5 years follow-up. Mortalities were 17.2% and 6.7% respectively. Short-term complication rate was of no significant difference in 2 groups. In hemiplegia group, short-term complication rate of femoral head replacement were significantly higher than that of total hip replacement. Conclusion Prosthetic re-placement is reliable to treat Garden type Ⅲ and type Ⅳ of femoral neck fractures of the hemiplegic ex-tremity in the elderly with previous stroke. Complications during perioperative period are more in hemiplegia group, but short-term complications are of no significant difference in 2 groups. Mortality of hemiplegia group is higher than in non-hemiplegia group in 5 years after operation. Total hip replacement should be in-dicated in treatment of Garden type Ⅲ and type Ⅳ of femoral neck fractures of the hemiplegic extremity in the elderly with previous stroke on condition that hip muscular strength is beyond Ⅳ degree.

Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB)is a commonly seen gastrointestinal emergency.Rockall and Blatchford scoring system are commonly used for risk stratification in ANVUGIB.Aims:To investigate the predictive values of Rockall and Blatchford scoring system for assessing the risk of blood transfusion,surgical intervention and mortality in patients with ANVUGIB.Methods:Five hundred and ninety hospitalized patients with ANVUGIB were scored by Rockall and Blatchford scoring system,respectively.Predictive values of these two scoring systems for assessing the risk of blood transfusion,surgical intervention and mortality were assessed by area under the receiver operating characteristic (ROC)curve (AUC).Results:Rockall and Blatchford scores in patients with blood transfusion,surgical intervention and died were significantly higher than those in patients without blood transfusion,surgical intervention and survived (P <0.01 ).The AUC of Rockall scoring system for predicting blood transfusion,surgical intervention and mortality were 0.785 (95% CI:0.743-0.828,P=0.000),0.765 (95% CI:0.693-0.837,P=0.000),0.835 (95% CI:0.703-0.966,P=0.005),respectively.The AUC of Blatchford scoring system for predicting blood transfusion,surgical intervention and mortality were 0.812 (95%CI:0.775-0.848,P=0.000),0.870 (95%CI:0.811-0.930,P=0.000),0.784 (95% CI:0.614-0.954,P=0.017),respectively.Conclusions:Rockall and Blatchford scoring system have high predictive value for blood transfusion,surgical intervention and mortality in patients with ANVUGIB.Rockall scoring system is better for predicting mortality,while Blatchford scoring system is better for predicting blood transfusion and surgical intervention.

Objective:To evaluate the role of the left ventricular ejection fraction (LVEF) in coronary artery bypass grafting(CABG)patients. Methods: From 2004 to 2005,215 patients underwent CABG and there were 36 cases with LVEF0.40(normal LVEF group). Correlative data of the two groups were compared and analyzed statistically. Results: Compared with the normal EF group, the EuroSCORE of the low EF group was much higher (mean 6.4?1.7) and many more patients of the low EF group had concomitant moderate to severe mitral valve insufficiency and aneurysm that needed simultaneous surgical operation(55.6%).Two patients died in hospital(5.5%)in the low EF group whereas five patients in the normal EF group(2.8%, P

Objective To estimate the value of fecal tumor M2-PK in the detection of colorectal adenoma and to evaluate its potential as a screening tool for colorectal adenoma.Methods Enzyme-linked immunosorbent assay (ELISA) was used to detect the fecal tumor M2-PK in stool samples of 65 patients with colorectal adenoma and 25 controls.At the same time,the peripheral blood tumor markers such as carcinoembryonic antigen (CEA),carbohydrate antigen (CA) 19-9,CA24-2 and fecal occult blood test (FOBT) were detected in the colorectal adenoma group.Results The detection value of fecal tumor M2-PK in the colorectal adenoma group showed a significant increase,compared with the control group((6.033±4.123) U/ml vs.(2.782±1.464) U/ml,t=-3.839,P=0.000).The highest detection value was found in the group where the diameter of adenoma was greater than or equal to 2 cm ((8.775±6.548) U/ml,t=9.635,P=0.034).The larger the diameter of adenoma,the higher the positive rate of fecal tumor M2-PK (85.7% vs.41.7% vs.29.6%,χ2=11.977,P=0.003).In the colorectal adenoma group,The positive detection rate of fecal tumor M2-PK was significantly higher than that of CEA,CA19-9,CA24-2 and FOBT (46.2% vs.6.2% vs.1.5% vs.1.5% vs.27.7%,?2=76.607,P=0.000).Conclusion Fecal tumor M2 pyruvate kinase has a good clinical value in the diagnosis of colorectal adenoma.

Objective:To observe the clinical efficacy of combining neuromuscular joint facilitation (NJF) with floating needle treatment in treating stroke survivors with painful shoulder subluxation.Methods:Thirty-nine stroke survivors with painful shoulder subluxation were randomly divided into an NJF group, a floating needle group and a combination group, each of 13. In addition to the basic treatment for shoulder subluxation and pain (including positioning, physiotherapy, active and passive motor function training, progressive training of the upper limbs, and using shoulder pads to protect the affected shoulders when standing or walking), the 3 groups were also given NJF, floating needle therapy or both as their group names imply six days per week for 4 weeks. Shoulder subluxation was evaluated using ultrasonography to measure the acromion-greater tuberosity distance (AGT). Pain was self-reported using a visual analogue scale. And the Fugl-Meyer assessment (FMA) was applied to quantify the treatments′ efficacy.Results:Before the treatment, no significant differences were found among the 3 groups in terms of their average AGTs, pain ratings or FMA scores. Afterward, significant improvement was observed in all of the measurements in all 3 groups, with the combination group′s average results significantly better than those of the other two. The combination group′s overall effectiveness was 85%, significantly better than that of NJF group (54%) and the floating needle group (62%).Conclusions:Floating needle treatment combined with NJF and routine rehabilitation can significantly improve motor functioning and relieve the pain of shoulder subluxation after a stroke.

Objective To investigate the effects of cholinergic pathway on acute renal tubular cell injury induced by acute oxygen and glucose deprivation. Methods Rat kidney macrophages were isolated and cultured for constructing macrophages and renal epithelial cells co-cultivating model of oxygen-glucose deprivation (OGD), and the model cells were divided into three groups: OGD alone group, acetylcholine (ACh 100μmol/L)+OGD group and ACh + galantamine (Gal 10μmol/L)+OGD group. The cells underwent OGD treatment for 1 hour, and normally cultured for 24 hours. The expressions of TNF alpha, IL-1 beta, and IL-10 in supernatant fluid were detected by ELISA, the renal tubular cell viability was determined by MTT assay, the expression of acetylcholine esterase (AChE) mRNA and protein were determined by RT-qPCR and Western blotting. The activity of AChE was determined by colorimetric method. Results The expressions of TNF alpha (pg/ml) in OGD, Ach+OGD group, Ach+Gal+OGD groups were 140.2±44.81, 119.46±4.42 and 103.31±1.62 respectively (P<0.05), those of IL-1β (pg/ml) were 172.26±13.51,144.34±5.53 and 119.37±11.42 respectively (P<0.05), and those of IL-10 (pg/ml) were 181.47±16.01, 173.62±10.12 and 188.36±8.73 respectively (P>0.05); The values of renal tubular cell proliferation were 55.02%±6.28%, 66.65%±6.47%, and 79.75%±4.22% respectively (P<0.01); the expressions of AChE mRNA in macrophages were 4.07±0.03, 4.22±0.15 and 3.98±0.29 respectively in the three groups (P>0.05); those of AchE protein were 0.66±0.07, 0.74±0.04 and 0.67±0.06 respectively (P>0.05); The activity of AChE (kU/L) was 0.51±0.02, 0.35±0.05 and 0.32±0.04 respectively (P=0.001, 0.001 and 0.368). Conclusions ACh and Gal could inhibit the secretion of inflammatory mediators and cholinesterase activity and can reduce the acute hypoxic renal tubular cell injury. The modulation of the cholinergic pathway in macrophages may be the important treatment method for acute renal injury in the future.

ObjectiveTo explore the viability,security and the curative effect of ultrasonic guided percutaneous portal vein puncture on autologous stem cells transplantation for patients with decompensated liver cirrhosis.MethodsSixty-four patients of decompensated liver cirrhosis with ascites were treated by autologous stem cell transplantation through ultrasonic guided percutaneous portal vein puncture.The clinical symptoms after transplantation,postoperative adverse reaction,the results of liver function tests were observed.Results After stem cells transplantation,patients' liver function got better obviously,laboratory indicators were better,postoperative adverse reaction and complication were less than those of 87patients treated with autologous stem cell transplantation into hepatic artery multilevel branch by pipe(P＜0.05).Conclusions Ultrasound guided percutaneous portal vein puncture on autologous stem cells transplantation is the viability,security,less side effect and effective for treatment patients with decompensated liver cirrhosis.It can be used as the clinical treatment methods for patients with middle-late liver cirrhosis.