Objective To investigate the identification role of plasma high sensitive Creactive protein (hs-CRP) and lipoprotein (a) (Lp [a]) levels in the diagnosis of patients with acute ischemic stroke according to the TOAST classification. Methods The levels of plasma hsCRP and Lp (a) in 82 acute stroke patients ( ＜24 hours) and 60 healthy controls were detected using immune scatter turbidimetry and immune transmission turbidity, and try to make use of Holter, ultrasonography, magnetic resonance imaging, magnetic resonance angiography/CT angiography/dagital subtraction angiography and other tests. Finally, they were classified according to the diagnostic criteria of the TOAST classification of ischemic stroke. Results There were significant differences in plasma hs-CRP and Lp (a) levels between all the subtypes of the acute ischemic sroke group and the control group (all P ＜0. 001). The the level of plasma hsCRP in patients with cardioembolism (CE) was highest. Hs-CRP could be used as a biological marker of CE subtype (odds ratio[OR] = 1. 84,95% confidence interval [CI] 1. 18-2. 85, P ＜ 0. 05). When its concentration was ＞ 3. 48 mg/L, the sensitivity and specificity of predicting CE were 89% and 83% respectively. The plasma level of the AT patients was highest, it could be used as a biological marker of AT subtype (OR = 1. 02, 95% CI 1. 01-1. 03, P＜0. 05); when its concentration was ＞ 183. 5 mg/L, the sensitivity and specificity of predicting AT were 87% and 85% respectively. Conclusions The plasma hs-CRP and Lp (a) levels of patients with acute ischemic stroke may provide some help for timely and accurate etiological typing.

P-selectin is also known as CD62. It promotes the occurrence of ischemic cerebrovascular disease by mediating the activation of endothelial cells and platelets as well as the processes of the formation and development of atherogenesis. A number of studies have confirmed that P-selectin plays important roles in the occurrence and development of the risk factors (such as hypertension, diabetes, hypercholesterolemia, heart disease, smoking, alcohol abuse and hyperfibrinogenemia) for ischemic cerebrovascular disease. It remains to be confirmed by further studies whether P-selectin can be used as an independent risk factor for predicting the occurrence of ischemic cerebrovascular disease.

The aim of our study was to observe changes of biliary trace elements and hepatolienal ultrasonography in patients with HL D treated synthetically by metal-binding a- gents DMSA and DMPS.Using Aloka SSD2 5 6 ultrasonography and WFX-1 E2 atomic ab- sorption spectrophotometer,we analysed and asseyed the sonograms and biliary trace ele- ments of30 patients with differentultrasonographic typesbefore and six weeksafter DMSA and DMPS treatment.Biliary B juice were obtained by duodenal drainage.The results showed that the biliary copper content of patients with glinting echogenic dots type,rock stratum type and tree-like type increaed markedly after therapy(P

Objective To study the correlation between GSTM1 genetic polymorphism and bladder cancer susceptibility. Methods In a case control study, the GSTM1 genotype was assessed by a PCR based method. 69 patients with transitional cell carcinoma of the bladder and 88 controls matched for age and sex were studied. Results The frequency of GSTM1 null genotype among the bladder cancer patients was 58% compared with 41% among controls(OR=2.0, 95%CI=1.05～ 3.79 ,? 2=4.51, P

Objective To study effect of nasal tolerance with rat-derived 97-116 peptide of AChR α-subunit(Rα97-116(V108A))on the manifestation of muscle weakness and the immunity function of experimental autoimmune myasthenia gravis(EAMG).Methods Twenty-two EAMG model Lewis rats immunized thrice with Rα97-116(V108A)were divided randomly into tolerance group and control group.They were respectively immunized with Rα97-116(V108A)and PBS buffer solution for 10 days via nasal mucous.Then the body weight and Lennon score of two group Lewis rats were measured.Their serum anti-AChR antibodies were tested by ELISA,the expression levels of CD28,CTLA4,B7-1 and B7-2 were determined by flow cytometry.Results Compared with control group at different time points.the body weight of tolerance group rats(tolerance group(228.1±5.8)g,control group(215.0±16.2)g,t=2.395,P＜0.05)increased,the mean clinical score of rats(tolerance group 1.55±0.44.control group 2.10±0.66,t=-2.20,P＜0.05)decreased and the amount of serum anti-AChR antibody(tolerance group 0.97±0.20,control group 1.27±0.26,t=-2.857,P＜0.05)decreased obviously.the amount of CD28,B7-1,B7-2,CTLA4(%)expressed on the surface of peripheral blood cells(tolerance group:27.35±7.05,4.73±0.58,2.71±0.35,1.72±0.44,control group:40.02±8.81,9.52±1.25,5.88±1.09,2.64±0.47)down-regulated markedly(t=3.479,10.861,8.755,4.403,all P＜0.01).Conclusion Nasal mucous tolerance with Rα97-116(V108A)could ameliorate muscular weakness of EAMG rats while activates T cell and inhibits B cellular immunity.

Objective To explore the effects of second biopsy and resection on tumor recurrence and progression in patients with high risk non-muscle invasive bladder cancer. Methods The second biopsy and resections were performed 4-6 weeks after the first transurethral resection in 52 patients. Routine follow-up was done in another 71 patients. The tumor recurrence and progression rates were compared. Results Residual tumors were found in 54%(28/52) of patients underwent second biop-sy and resection, including muscle-invasive tumors in 5 patients. Two patients underwent radical cys-tectomy due to resection findings. During same period, 71 patients were routinely followed. After a median observation of 27 months, patients underwent second biopsy and resection showed lower recur-rence rate (P<0.05). The progression rate was no difference between the 2 groups(P0.05). Conclusion Second biopsy and resection may reduce recurrence rate in high risk non-muscle invasive bladder cancers, but may not change the tumor progression rate.

Objective To compare the long-term outcomes in patients with newly diagnosed stage T1G3 bladder cancer treated with bladder preserving approach and intravesical instillation or im-mediate cystectomy.Methods of 113 patients with a median age of 64 years (range 27 to 88) diag-nosed with T1G3 bladder cancer from January 1993 to February 2007,81 cases were treated by tran-sureteral resection with additional intravesieal instillation and 32 were treated with immediate cystecto-my.Differences between the 2 groups in 5-year overall survival and tumor specific survival were calcu-lated using the Kaplan-Meier survival function and analyzed by the log rank test.Results of 81 pa-tients treated with organ preserving approach and postoperative intravesical instillation,53 patients developed local recurrence and 21 patients underwent deferred cysteetomy in a median 64 (range 6-140) months follow-up.The overall and tumor specific survival at 5 years was 64.2% (52/81) and 77.8%(63/81),and in those who had deferred cystectomy it was 61.9% (13/21) and 76.2% (16/21),respectively.Of the 32 patients treated with immediate cystectomy,the 5-year overall and tumor specific survival was 59.4%(19/32) and 75.0%(24/32) within a median follow-up of 62(range 4-141)months.There was no statistical difference of the 5-year overall and tumor specific survival be-tween patients treated with bladder preserving approach or immediate cystectomy.Conclusion Blad-der preserving approach and immediate eystectomy might have similar 5-year overall and tumor specific survival for primary T1G3 bladder cancers.

Objective To identify gene mutations and explore the molecular mechanism of a pedigree with inherited coagulation F Ⅶ deficiency. Methods The levels of F Ⅶ: Ag in the proband and other family members were measured by ELISA assay. The values of PT, F Ⅶ: C and other coagulant parameters were determined by one-stage clotting for laboratory phenotype diagnosis. All the exons,exon-intron boundaries and 5',3' untranslated sequences of F7 gene were amplified by direct sequencing. The detected mutations were further confirmed by sequencing the other stand. The CLC Protein Workbench software was used to analyze the species conservation of the mutated site and the protein secondary structure. 100 healthy individuals were selected to exclude gene polymorphism. Results PT, FⅦ∶C and FⅦ: Ag in the proband and his sister were abnormal, which were 36. 3 s, 5.0%, 40. 7% and 33.4 s,5. 0%, 37.4%, respectively. Both PT and FⅦ∶C in the proband's father, mother, daughter and niece were slightly abnormal, which were 14.9 s, 14. 6 s, 15.5 s, 14. 6 s and 70%, 85%, 59%, 79%, respectively.The heterozygous mutations c. 784T ＞ C and c. 964T ＞ G in exon 8 of F7 gene were found in the proband,resulting in the substitutions of Ser269Pro and Cys329Gly respectively. Compound heterozygous mutations c. 784T ＞ C and c. 964T ＞ G were found in the proband's sister. The proband's mother was heterozygous for c. 784T ＞ C. His father, daughter and niece were heterozygous for c. 964T ＞ G. The protein biological characteristics analysis revealed that the Cys329Gly caused the change of spatial configuration, and Ser269Pro led to the change of amino acid polarity and hydrophobicity. Conclusion Compound heterozygous mutations of Cys329Gly and Ser269 Pro in F7 gene may be the underlying molecule mechanism of FⅦ deficiency in this pedigree.

Objective To investigate the variety and clinical value of the neutrophil volume and cytoplasm-nucleus complex in patients with bacterial infection, cardiovascular or cerebrovascular accident and major surgery operation. Methods 125 patients with bacterial infection, 64 patients with acute cardiovascular or cerebrovascular accident, 66 patients after major surgery operation and 69 normal subjects were selected in the study. Total WBC counts (WBC), percentage of neutrophils (NE), and the VCS parameters of neutrephils including the mean channels of cell volume ( NEV), conductivity ( NEC), light scatter(NES) and the SD of these parameters( NEVSD, NECSD, NESSD)were measured by automatic blood cell analyzing instrument. The sensitivity and specificity of the WBC, NE and the VCS parameters of neutrophils were analyzed with receive operating characteristic (ROC) curve. Results The levels of NEV, NES and NEVSD in acute bacterial infection group were 154.3 ± 15.2, 135.7 ± 9.9, 26.8 ± 4.2 respectively. The levels of NEV, NES and NEVSD in post major surgery operation group were 147.2±8.9, 141.5 ± 7.7, 23.0 ± 2. 8 respectively. The levels of NEV, NES and NEVSD in acute cardiovascular or cerebruvascular accident group were 144.9 ± 5. 2, 146.0 ±5.0, 19. 6±1.6 respectively. The levels of NEV, NES and NEVSD in healthy control group were 139.7±4.6, 145.0±3.8, 18.2±1.3 respectively. The differences of these parameters among these groups had statistical significance ( F = 17. 650, 38. 122, 54. 604,P<0. 05). And the changes of NEV, NES and NEVSD in bacterial infection group were most obvious among those three groups. The levels of NEV, NES and NEVSD were 146.5±9.5, 144.3 ± 9.4, 21.3 ± 3.3 respectively in stress diseases groups which included acute cardiovascular or cerebrovascular accident group and post major surgery operation group. The differences of these parameters between stress diseases group and acute bacterial infection group had statistical significance ( t = - 2.840, 7.533, - 8.999,P<0.01). The areas under the ROC curve of NEVSD, NEC, NES and NECSD were 0.893, 0. 845, 0. 833 and 0. 849 respectively. The sensitivity of 83. 3% and specificity of 82. 0% could be achieved by selecting the cut-off equal to or greater than 24. 0. Conclusions The variety of neutrophil volume, nuclear size and cytoplasmic granularity changed obviously in patients with acute bacterial infection and common stress diseases, and the variety in acute bacterial infection is more obvious than that in common stress diseases. The sensitivity and specificity of VCS parameters of neutrophils are higher than those of WBC or NE for predicting infection, and the NEVSD is the most predictable indicator of acute bacterial infection.

Objective To compare the efficacy of different analgesia regimens in elderly patients with femoral neck fracture undergoing posture changing during epidural anesthesia. Methods Ninety patients (35 males,55 females,aged 65-90 years,48-78 kg)with femoral neck fracture who would be treated with artificial femoral head replacement were randomly divided into 3 groups (n = 30 each):femoral nerve block group (group FNB),fascia iliaca compartment block group (group FIC)and intravenous group (group IV).Femoral nerve block or fascia iliaca compart-ment block was performed 30 min before epidural anesthesia (EA)in FNB group or FIC group re-spectively.Fentanyl 0.5 μg/kg was injected intravenously 3 min before EA.In the three groups,addi-tional 0.25 μg/kg fentanyl was administrated intravenously to keep the VAS scores <4 before posi-tioning.EA was performed between L1-2 in a position of troubled leg upper,and patients returned to supine position after epidural catheterization.The VAS scores at T0 (after entering the operation room),T1 (in supine posture before EA),T2 (before posture changing),T3 (while supine from lateral posture after EA),T4 (3 min after T3 ),the time for achieving EA,the fentanyl consumption, the cases of cardiovascular events and hypoxemia was recorded.Results Compared with group IV, VAS scores at T1 ,T2 ,the fentanyl consumption,time for achieving EA,and incidence of cardiovas-cular events and hypoxemia in group FNB and group FIC decreased significantly (P <0.05 or 0.01). There was no significant difference between group FNB and group FIC.Conclusion Preemptive anal-gesia regimens through both femoral nerve block and fascia iliaca compartment block during epidural anesthesia can reduce the fentanyl consumption,as well as decrease the incidence of cardiovascular e-vents and hypoxemia.