ObjectiveTo determine the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism in Han ethnic patients with type 2 diabetes in Chenzhou area of Hunan province,and to assess the assoeiation between this polymorphism and diabetes.MethodsThis study was cross-sectional designed.Samples were taken by random sampling method from diabetes, prediabetes and euglycemia subjeers.ACE gene polymorphism I/D were examined by PCR.Genotype was classified as I1, ID, or DD based on positive or negative insertion/deletion allele.ResultsThis study showed significant differences of ages (X2 =32.09, P ＜0.01), body mass index (BMI) (X2 =16.10, P ＜0.01), family history (X2 =20.42, P ＜0.01) and serum triglyceride (F =21.289, P ＜0.01) among three groups, and diabetes group tended to have higher value.Frequency of genotype II, ID, DD were 72(56.3％) ,52(40.6％) and 4(3.1％) in diabetes, 64(64.0％) ,30(30.0％) and 6(6.0％) in pre-diabetes subjects, 81 (72.3％),29(25.9％)和 2(1.8％) in euglycemia subjects, consecutively.Chi-square analysis showed statistically significant association between ID + DD vs.Ⅱ genotype and diabetes (x2 = 6.68, P ＜ 0.05).Logistic regression analysis showed four variables that significantly influence to diabetes, namely ACE gene polymorphism, family history of diabetes, BMI, and serum triglyceride level.ConclusionsACE ID + DD genotype had significant relationship with diabetes in Chenzhou Han ethnic population, Hunan province, China.

Objective: To explore the effects of Interlock controllable spring coils for limiting blood flow of TIPS shunt in refractory hepatic encephalopathy patient after TIPS. Methods: Interlock controllable spring coils were used to restrict shunt flow in 5 patients with refractory hepatic encephalopathy after TIPS operation. Results: Totally 7 controllable spring coils were implanted in all 5 cases, including 3 coils of 10 mm×25 cm, 1 coil of 15 mm×25 cm and 3 coils of 10 mm×40 cm. Combined with symptomatic treatment after TIPS, the symptoms of hepatic encephalopathy were significantly improved in 1 patient, while in 2 patients recurrent hepatic encephalopathy symptoms were observed within 2 months after restriction and disappeared after the second restriction. In 2 patients with symptoms of portal vein hypertension 2 weeks after the first restriction, 8 mm×60 mm balloon was selected to expand the shunt channel, and then 8 mm×60 mm Nitinol alloy stent was implanted in each one, and no symptom of hepatic encephalopathy nor portal vein hypertension occurred after the stent implantation. Conclusion: It is safe and reliable to treat refractory hepatic encephalopathy after TIPS (5 cases) with coils implantation for limiting blood flow.

Objective To investigate the effects of recombinant human osteoprotegerin(rhOPG) on RANKL ,OPG protein expression in alveolar bone tissue of rats with periodontitis to provide the experimental evidence for the application of rhOPG in pe‐riodontitis treatment .Methods Totally 22 Wistar rats were enrolled .The random number table was adopted to select two healthy rats as the healthy group .The rest 20 rats were selected as the experimental group for establishing the rat models of periodontitis , and then subdivided into the experimental control group (n=10) and rhOPG group (n=10) .Rats in the rhOPG group were locally injected by rhOPG 10 mg/kg at periodontal pocket gap of maxillary second molar ,while those in the experimental control group were injected by sterile water for injection at the same site and some volume .The streptavidin‐perosidase(SP) method was em‐ployed to detect the expression of RANKL ,OPG protein in alveolar bone tissue .Results Compared with the healthy group ,the ex‐pression levels of OPG in alveolar bone tissue of rats in the experimental group were lower with statistically significant difference (P<0 .05) ,while the difference of RANKL expression levels between the two groups showed no statistical significance(P>0 .05) . Compared with the experimental control group ,the expression level of OPG protein in alveolar bone tissue of rats in the rhOPG group was significantly up‐regulated ,while that of RANKL protein was significantly down‐regulated(P<0 .05) .The OPG expres‐sion level after treatment in the rhOPG group was markedly enhanced ,while the RANKL expression level was reduced compared with before treatment ,the difference was statistically significant (P<0 .05) .Conclusion rhOPG may regulates the expression of RANKL and OPG in alveolar bone tissue of rats with periodontitis .

Aim To explore the effect of genetic poly-morphisms of POR on the stable warfarin maintenance doses in Han Chinese patients receiving mechanical heart valve replacement. Methods The association between POR gene polymorphisms and warfarin doses of 185 Han Chinese patients were investigated through ANOVA or t test. SNPs of POR and VKORC1 were de-tected by Sequenom? DNA MassArray genotyping method. CYP2C9*3 was genotyped by polymerase chain reaction-restriction fragment length polymorphism method ( PCR-RFLP ) . Patients ’ clinical characteris-tics, INR value and daily dose were obtained from their medical records. Statistical analysis was performed by SPSS 21. 0 software. Results No mutant carriers of POR rs17148944 , POR rs56256515 and rs72553971 were found in this study. The genotype frequencies of other SNPs were in accordance with Hardy-Weinberg e-quilibrium. In the group of patients with CYP2C9*1*1 , the mutant type carriers ( T carriers ) of POR rs17685 had a significantly higher dose than CC carri-ers(3. 50 ± 1. 07) mg·d-1 vs (3. 14 ± 0. 94) mg· d-1,P =0. 03. Also, in the group of patients with CYP2 C9*1*1 and VKORC1 rs9934438 G allele carri-ers, the mutant type carriers ( T carriers ) of POR rs17685 had a significantly higher dose than CC carri-ers(4. 76 ± 0. 90) mg·d-1 vs (4. 08 ± 1. 03) mg· d-1 ,P=0. 04. No significant difference was found in different genotypes of POR rs2868177 . Conclusion These results illustrate that POR rs17685 T carrier is closely associated with a higher warfarin maintenance dose, suggesting that this SNP is useful for clinical guidance of warfarin.

Objective: To observe the influence of acupuncture at Zusanli (ST 36) and Xuanzhong (GB 39) on cerebral vasomotoricity of ischemic stroke and its possible mechanism.Methods: All the appropriate cases were randomly divided into treatment and control groups with 80 cases in each group. The routine treatment of cerebral apoplexy was given to the two groups. Zusanli (ST 36) and Xuanzhong (GB 39) were added to the treatment group. The change of velocity of blood blow of the cerebral central artery was observed by transfrontal Doppler ultrasound detecting method before and after treatment to evaluate the cerebral basomotoricity of the patients. Results: The cerebral vasomotoricity in the treatment group was greatly improved compared with pre-treatment (P＜0.05) and there was a significant difference compared with the control group (P＜0.05). Conclusion: Acupuncture at Zusanli (ST 36) and Xuanzhong (GB 39) could obviously improve the cerebral vosomotoricity of the patients with cerebral ischemic stroke, which might be one of the action mechanisms of acupuncture treatment for cerebral ischemic stroke.

Objective To study clinical efficacy on cesarean scar pregnancy (CSP) treated by transvaginal surgery.Methods From Jan.2008 to Mar.2011,31 cases with CSP were managed by transvaginal surgery in Anshan Women and Children Hospital.Based on ultrasonograpy examination and intraoperative exposure of lesion,variable surgical options were executed.Fifteen cases in group A were treated by debridement resection and vaginal repair of uterine wall,7 cases in group B were treated by transvaginal uterine artery ligation and curettage,9 cases were treated by cutting the anterior wall in the lower uterine segment and repairing uterine.The intraoperative blood loss,operation time,hospital stay,hCG fluctuation at postoperative period and complications were analyzed among those groups.Results Allcases in 3 groups were cured well in one time.( 1 ) The intraoperative blood loss were (41 ±21 ) ml in group A,(27 ±7) ml in group B and ( 148 ± 132) ml in group C.There was no statistically different blood loss between group A and group B ( P ＞ 0.05 ),however,the amount blood loss in group C was significantly more than those in group A and group B ( P ＜ 0.05 ).( 2 ) The average surgical time,the mean hospital stay,postoperative recovery time of blood hCG were (40 ± 11 ) minutes,(4.7 ± 0.8 ) days and ( 2.7 ± 1.0) weeks in group A,(44 ± 5 ) minutes,(4.0 ± 0.8) days and (2.9 ± 1.0) weeks in group B,(40 ± 12) minutes,(4.9 ± 1.0) days and (2.8 ±0.9) weeks in group C.Those clinical index were no statistically different among those 3 groups(P ＞0.05).(3) No bladder injury and other complications were observed in those groups.Conclusions Transvaginal surgery is efficacy,easy to operate,to keep the uterus,safe and economy in treatment of CSP.Surgery in group A is suitable to treat early and exogenous lesions; surgery in group B is suitable to treat endogenous lesions; surgery in group C is suitable to treat failure cases in group A and B,however,the injury is greater than those in group A and B.

Objective To estimate the application frequency of X-ray diagnosis in Fujian province in 2016 based on the examination number survey in sampled hospitals in 9 cities.Methods Using the national unified questionnaire and stratified typical sampling method,a total of 43 hospitals in 9 cities of Fujian province were selected for the survey.The survey information mainly contained the basic situation of sampled hospitals and the number of X-ray diagnostic examinees.The basic situation included the numbers of out-patient and emergency care,in-patient,X-ray diagnostic equipment and radiological staff,and the examinees were further classified by examination types,gender,ages and beam positions.Furthermore,based on the survey result,a prediction model of the application frequency of X-ray diagnosis in Fujian province was established,and the frequency in 2016 was also estimated.Results There were 418 sets of X-ray diagnostic equipment,and 1 230 radiological diagnostic staff in the 43 hospitals.The total number of out-patient,emergency care and in-patient was 30 919 162,and the number of X-ray diagnostic examinations was 4 277 518 in the hospitals in 2016.In 2016,the application frequency of X-ray diagnosis in Fujian province was estimated to be 695 examinations per thousand population.Among them,the frequencies of conventional X-ray photography and CT examinations were 373 and 293 examinations per thousand population,respectively.Conclusions Through this survey,the general situation of X-ray diagnostic application in Fujian province in 2016 was grasped,so as to provide reference data for improving the regulations and standards of radiation health protection and strengthening the supervision and management of the application of X-ray diagnostic equipment in Fujian province.

OBJECTIVE: To report a patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) manifesting as lumbago, hunchback and Parkinson's syndrome. METHODS: A 49-years-old male CADASIL patient was reported. Results of clinical examination, neuroimaging and genetic testing were analyzed. His family members were also subjected to genetic testing. Related literature was reviewed. RESULTS: The patient had no typical symptoms of CADASIL such as headache, repeated stroke, dementia and emotional disorders, but progressive Parkinson's syndrome, late onset lumbago, hunchback, dysphagia, and diplopia. Brain MRI showed left basal ganglia and external capsule lacunar infarction. Genetic testing revealed a point mutation c.1630C>T (p.R544C) in exon 11 of the NOTCH3 gene. A heterozygous mutation was detected in the same gene in his mother, elder sister and younger brother, all of whom showed different clinical phenotypes. CONCLUSION The clinical features of CADASIL are heterogeneous. Lumbago, humpback, and Parkinson's syndrome may be a rare clinical phenotype of CADASIL.
CADASIL ; complications ; genetics ; Humans ; Low Back Pain ; etiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mutation ; Parkinson Disease ; etiology ; Receptor, Notch3 ; genetics

Objective:To analyze the clinical features of autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A).Methods:A retrospective analysis was performed. Data of 14 patients with GFAP-A, admitted to Department of Neurology, Chenzhou First People's Hospital from December 1, 2020 to May 1, 2022, were collected.Results:The mean age of these 14 patients was (46±31) years, and the male patients were more than female ones (10∶4). All patients had acute onset, and the main clinical symptoms included dizziness and headache ( n=10), fever ( n=8), urination and defecation function disturbance ( n=5), mental and behavioral abnormality ( n=4), limb weakness ( n=4), and tremor ( n=3). No tumors were found; 8 patients were with hyponatremia. Twelve patients responded well to hormone and/or immunosuppressive therapy; 2 patients refused corticosteroid and/or immunosuppressive therapy for personal reasons, and their condition did not improve at discharge. Conclusion:In these GFAP-A patients, relatively heterogeneous clinical manifestations are noted; many are complicated with hyponatremia, and some have clinical manifestations similar to nervous system infectious diseases; the prognosis is good after immunotherapy.

Objective To investigate the clinical efficacy and complications of minimally invasive transforaminal lumbar-interbody fusion (TLIF) in the treatment of lumbar spondylolisthesis. Methods Total 142 patients with single level spondylolis-thesis who treated by TLIF from 2010.01 to 2015.06 were included in this study, with 68 cases in minimally invasive TLIF (MIS-TLIF) group and 74 cases in traditional open TLIF group. The general information (age, gender, isthmic or degenerative type, per-centage of slip degree, levels), operative time, blood loss, length of postoperative hospital stay, Visual Analogue Scale (VAS) of low-back pain and leg pain, and Oswestry Disability Index (ODI) were recorded and collected. The posterior height of the interverte-bralpace and segmental lordosis, reduction of spondylolisthesis and cross-sectional area of spinal canal were measured. Results There was no statistically significant difference between the two groups in age, gender ratio, percentage of slip degree, and sur-gicallevels distribution. Total of 66 cases in MIS-TLIF group and 71 cases in Open TLIF group finished 2 years follow up, and 25 cases in MIS-TLIF group and 31 cases in Open TLIF group finished 5 years follow up. The blood loss of the MIS-TLIF group was 164.7±51.7 ml, significantly lower than the open TLIF group of 239±69.3 ml(P<0.001). The length of postoperative hospital stay was 5.9 ± 1.5 days in MIS-TLIF group, significantly shorter than the open TLIF group of 7.3 ± 3.1 days(P<0.001). The operative time of MIS-TLIF and Open TLIF was 146.3±21.9 mins, 152.0±20.4 mins, respectively, and no significant differ-ence was found between them. The VAS ofback pain, leg pain, ODI in MIS-TLIF group was 1.76±1.16, 1.91±1.36 and 23.5± 7.3 at 2 years follow up, and in Open TLIF was 1.73±1.10, 1.83±1.36 and 23.8±6.7, respectively, all of them were significant-ly different to pre-operation, however, no significant difference was found between two groups. The VAS of back pain, leg pain, ODI in MIS-TLIF group was 1.73±1.21, 1.93±1.48, and 25.4±6.8 at 5years follow up, and in Open TLIF was 1.85±1.02, 1.85± 1.33 and 26.1 ± 6.5, respectively, no significant difference between twogroups. The posterior height of the intervertebral space and segmental lordosis of MIS-TLIF was 9.52±1.67 mm and 12.11°±3.44° at 2 years follow up, while the open TLIF was 9.88± 1.54 mm and 12.98 ± 3.83° , all of them were significantly different to pre-operation,however, no significant difference between two groups. The posterior height of the intervertebral space and segmental lordosis of MIS-TLIF was 9.37 ± 1.46 mm and 11.55° ± 2.77° , while the open TLIF was 9.66 ± 1.68 mm and 12.59° ± 4.23° , no significant difference between two groups. The percentage of slip degree was reduced to 5.2％±4.6％ in MIS-TLIF and 5.6％±4.3％ in open TLIF, the cross-sectional area of spinal canal was enlarged to 139.7±19.5 mm2 and 141.7±20.7 mm2, no significant difference between two groups either. Con-clusion MIS-TLIF has less blood loss, shorter postoperative hospital stay than open TLIF, and similar clinical pain and function-al outcomes. MIS-TLIF is suggested to be a safe and effective choice in the treatment of lower grade lumbar spondylolisthesis (Grade II or less).