BACKGROUND: Ischemic preconditioning (IPC) can effectively improve the ischemic resistance of skeletal muscle and reduce the necrotic areas during ischemia-reperfusion; However, the impacts of IPC on contractile function of skeletal muscle during ischemia-reperfusion is unclear.OBJECTIVE: To investigate the effect of IPC on contractile function of skeletal muscle during ischemia-reperfusion.DESIGN: A randomized controlled study by employing experimental animals as subjects.SETTING: Tongji Medical College, Huazhong University of Science and Technology and the 252 Hospital of Chinese PLA.MATERIALS: The experiment was completed in the 252 hospital of Chinese PLA. Totally 14 healthy SD rats were involved.METHODS: A rat right hindlimb ischemic model was utilized, 14 SD rats were randomly divided into control group and experimental group. Control group: sustained ischemia for 4 hours and reperfusion of 1 hour. Experimental group: ischemia for 5 minutes and reperfusion for 5 minutes, after 3 cycles, ischemia for 4 hours and reperfusion for 1 hour continuously of IPC.The isometric twitch contractile force of the right gastrocnemius muscle was measured as a parameter indicating the muscle functional status during is chemia reperfusion. The changes of creatine kinase (CK), malondialdehyde (MDA) in blood sample and the uptake of 99Tcm-methylene diphosphonate (99TcmMDP) in skeletal muscle were measured after 1 hour of reperfusion.MAIN OUTCOME MEASURES: The impacts of IPC on contractile force of gastroenemius and serous CK, MDA and the uptake of 99TcmMDP.RESULTS: The muscle contractile force in the experimental group after four hours of ischemia was (14.32 ± 5.05) g or (25.71 ± 7.58) g after one-hour reperfusion, which was significantly higher than 0 g or (4. 73 ± 2.05) g of control group(P ＜0. 05). The serous levelsofCK [(104.85 ±9. 84) nkat/L], MDA [ (3 988.60 ± 455.92) nmol/L] and the uptake of 99TcmMDP [ (56.0± 8.1 ) mBq/g per minute] were significantly lower in the experimental group than control group [CK(136.36 ± 14.50) nkat/L, MDA (6 542.90±536.72)nmol/L, and 99TcmMDP (97.3 ±5.8) mBq/g per minute, P＜0.05, P ＜0.01].CONCLUSION: IPC can effectively ameliorate the contractile force of skeletal muscle and reduce the necrotic degree of skeletal muscle. Therefore, IPC has a protective effect on the contractile force of ischemic skeletal muscle.

Objective To analyze the radiologic features of intestinal duplications in children and improve the diagnostic rate of this disease presurgical resection.Methods The clinical presentation and imaging data of eight cases confirmed surgically and patho-logically with intestinal duplications were retrospectively analyzed,as well as reviewed based on literature review.Results 8 cases were given ultrasonography,7 of them had positive performance.7 csaes were given CT scan and 6 of them had positive performance. 6 cases had ECT examination and 4 of them were positive.Their positive rates were 87.5%,85.7%,66.7% respectively.The posi-tive rates were all 100% combining ultrasonography with CT or CT with ECT.Conclusion Ultrasonography,CT and ECT is helpful to diagnose of intestinal duplications in children,their results are the no-specificity.Choosing a suitable imaging examination is useful to offer a pre-operative diagnosis.

Objective To investigate the effect of swifch from cyclosporine to FK506 on renal allograft outcome after initial acute rejection. Methods Clinical outcome of patients who experienced first acute rejection episode were retrospectively analyzed. After initial acute rejection, 23 patients were switched to FK506-based immunosuppression, and 63 patients continued CsA-based immunosuppression. Demographic data, lipid, serum creatinine, uric acid, incidence of recurrent acute rejection and graft survival were analyzed and compared. Results During one year after anti-rejection therapy, incidence of biopsy-proved recurrent rejection events was significantly lower with FK506 therapy (1/23, 4.35%) compared with CsA therapy (16/63, 25.40%)(P=0.033). 5-year graft survival rate of FK506-based immunosuppression group was higher than that of CsA-based immunosuppression group (100.0% vs 81.4%). Serum uric acid level of FK506-based immunosuppression group from 24 months to 36 months after initial rejection were significantly lower than that of CsA-based immunosuppression group [(265.5 ±147.9) μmol/L, (245.8±88.9) μmol/L vs (428.5±119.3) μmol/L, (441.2±125.3) μmol/L, P<0.01, respectively]. Conclusion Conversion to FK506 therapy can significantly reduce recurrent rejection episode, and decreasing serum uric acid level provides long-term benefits to graft survival.

BACKGROUND: Gong's nonverbal intelligence test(GNIT) is a nonverbal and cross-cultural test of intelligence designed primarily to suit the use in the minority groups and those with linguistic difficulties by Professor Gong Yao-xian. At present 5 unified norms of the minority groups as well as norms of Chinese Han children and adult aged below 55 years have been developed, but the norms for the elderly above 56 years of age are not available. Nonverbal intelligence test is especially suitable for the elderly and has therefore wide applications.OBJECTIVE: To establish regional norms of the GNIT for healthy elderly people above 56 to enable the completion of nonverbal intelligence test norms suitable for each age groups.DESIGN: A controlled study with stratified sampling of healthy elderly retirees over 56 years of age in the community.SETTING: Department of Physiology in Medical College of Henan University of Science and Technology; Center for Psychology, Xiangya Second Hospital,Central South University.PARTICIPANTS: Healthy elderly retirees above 56 years of age in Luoyang cityor the counties were selected on a voluntary basis with stratified sampling according to the proportion of each region. The selected subjects aged between 56 and 101 years, and 8 age groups were divided at the interval of 5 years(about 200 people in each age group). Totally 1 460 subjects were selected, including 679 male and 781 female subjects.METHODS: With the instruments and manual of GNIT, the subjects were tested for color identification, classification, blank-filling with numbers or graphs, characters and encoding tests. The results were original scores, scale scores and intelligence quotient.MAIN OUTCOME MEASURES: The norms of GNIT for the elderly above 56 years of age.RESULTS: The norms included three scores, namely the original scores, scale scores and standard deviation scores. To test of reliability and validity of the norms, retest was performed in 40 1 or 2 weeks after the initial test, resulting in the test-retest reliability coefficient ranging from 0.59 to 0. 89, with the total test-retest reliability coefficient of 0.83. The correlation coefficients the original scores between the subtests ranged from 0. 35 to 0. 63, and the correlation coefficients between the standard deviation scores of the verbal intelligence quotient(VIQ), performance intelligence quotient(PIQ) and full intelligence quotient(FIQ) of Wechster intelligence scale for children(WAIC-RC) were 0.43,0.51 and 0.54 respectiyely, based on a study of a sample of 50 elderly subjects.CONCLUSION: Primary regional norms of GNIT for elderly subjects above 56 years of age have been established to measure mainly the perception and reasoning factors loaded with also visual motor psychological factors and abstract summary factors, with satisfactory reliability and validity equivalent to similar tests.

Objective To explore the efficacy and safety of percutaneous transhepatic portal vein or transjugular intrahepatic portosystemie shunt (TIPS)to implant the portal vein metallic stent in treatment of cavernous transformation of portal vein (CTPV).Methods Clinical and imaging data of 8 patients with CTPV were retrospectively analyzed who were treated in our hospital.All patients were treated with metallic stent implantation in portal vein including 3 patients by TIPS and 5 by percutaneous transhepatic portal vein.Results All patients were successful in the stent implantation without any occurrence of serious complications such as intra-abdominal hemorrhage and so on.Intraoperative angiography showed blood circulated freely in these stents.1 day-2 weeks later,the patients symptoms of abdominal pain and gastrointestinal bleeding were obviously relieved or disappeared.Follow up 1 month-3 years,1 patient with stent occlusion after one year of operation,the blood flow recovery after stent reimplantation,and the remaining patients,color doppler ultrasound reflected patency of blood flows in their stents.No one suffered from gastrointestinal bleeding or abdominal pain again.Conclusion Implantation of portal vein metallic stent via percutaneous transhepatic portal vein or via TIPS in treatment of cavernous transformation of portal vein is safe and effective.

Objective To observe the value of one-step spectral imaging and perfusion imaging in diagnosis of solitary pulmonary nodule(SPN).Methods Forty-seven patients with SPN proved by pathology underwent perfusion scan with gemstone spectral ima-ging mode,who were divided into malignant group in 28 patients and benign one in 1 9.The parameters of CT perfusion including blood volume (BV),blood flow (BF),mean transit time (MTT)and permeability surface (PS)were analyzed.Iodine concentration (IC),normalized iodine concentration (NIC)and slope rate of spectral curve in both arterial phase and venous phase were measured and calculated.The independent sample t test was performed to compare quantitative parameters between malignant and benign SPN.Results BF,BV and PS of malignant SPN were higher than those of benign ones (P <0.05).No statistically significantly differences between malignant and benign SPN were found (P >0.05).IC,NIC and slope rate of spectral curve in malignant SPN were higher than those in benign ones in both phases (P <0.05).Conclusion One-step spectral imaging and perfusion imaging can provide more parameters,which is helpful for the diagnosis of SPN.

Objective To observe the value of iterative model reconstruction(IMR)technique in CT pulmonary angiography (CTPA)with lower radiation dose and lower contrast medium.Methods 60 patients with clinical suspicion of pulmonary embolism underwent 256-slice CTPA were prospectively enrolled.The raw data of test group(n=30)were reconstructed by filtered back projection (FBP)(group A)and IMR technique (group B).And the raw data of control group(n=30)were reconstructed by FBP(group C).The values of volume CT dose index(CTDIvol),effective radiation dose (ED)were recorded and calculated.The image quality parameters:CT value,image noise,signal-to-noise (SNR),contrast-to-noise ratio (CNR)and subjective image score(from one to five)were measured and compared between group A and B,B and C.Results The BMI was no statistically significant difierenee between two groups(P=0.001).The CTDIvol, ED on test group were respectively lower than that on control(P<0.001).The CT value was no statistically significant difierenee between group A and B(P=0.999).The CT valueon group B was higher than that on group C(P=0.005).The image noise on group B was lower than that on group A(P<0.001),but which was higher than that on group C(P<0.096).The SNR,CNR on group B were higher than that on group A(P<0.001).The SNR,CNR did not differ significantly between B and C(P=0.831,P=0.958).The diagnosable rate and good quality rate on group B were higher than that on group A(P<0.001),and there were no significantly diferent between B and C(P=1.000).Conclusion The application of optimized IMR technique can improve image quality at lower radiation dose and lower contrast medium for CTPA.

Objective To explore the feasibility of high-pitch CT pulmonary angiography (CTPA)with low dose contrast medium optimization in dual-source CT.Methods Eighty patients with high risk of pulmonary embolism who underwent CTPA on a dual-source CT were divided into two groups randomly:Group A,40 patients,50 mL contrast medium per patient,with conventional bolus tracing scanning;Group B,40 patients,contrast medium=body weight×0.3 mL/kg,with test bolus of small dose contrast agent. Pulmonary artery CT value,the differences of CT values in the paired PA and PV,SNR,CNR,radiation dose of two Groups were compared by two sample t-test.The positive rate of pulmonary embolism and the subjective indexes for assessing CT image quality were compared byχ2 test.Results There were no difference of the positive rate of PE between two Groups (P =0.655),and no sta-tistical difference for image quality scores between two Groups(P =0.1 74).The MPA CT value and the differences of CT values in the paired PA and PV in L-SⅢ of Group B were higher than those in Group A (P =0.001).However,no significant differences in CNR and SNR in MPA were observed between the two Groups(P =0.250,0.203,respectively).The ED of Group B was lower than that of Group A (P =0.001).Conclusion High-pitch CTPA in dual-source CT with lower dose contrast medium optimization can minimize the amount of contrast agent while meeting the clinical requirements.

Objective To investigate the clinical efficacy of transthoracic echocardiography (TTE) in catheter interventional treatment of congenital heart disease. Methods 57 patients with congenital heart disease were selected by preoperative TTE screening and then received Amplatzer occluder interventional treatment under X-ray monitoring. 23 of them were atrial septal defect (ASD), 29 were ventricular septal defect (VSD), 4 were patent ductus arteriosus (PDA), and one was VSD complicated with ASD. Results All the patients were treated successfully. The occlusion effect was observed by follow-up immediately after the procedure, and one week, one month, three months, six months, and one year after the procedure. The position of the occluder did not change, the surrounding of the occluder has no residual shunt. 3 cases of ASD and 2 of VSD were failed to plugged. Conclusions TTE has important clinical values in selection of the patients with indication , intraoperative detection of the release of Amplatzer, and postoperatve assessment of the efficacy.

Objective To evaluate the effects of different strategies on short-and long-term clinical outcomes of renal transplantation in Chinese subjects.Methods 2520 renal transplantations were retrospectively evaluated,including 2490 first renal transplantations and 30 second renal transplantations.Triple-immunosuppressant including cyclosporine A,azathioprine or myeophenolate mofetil(MMF)and prednisone(Pred)was adopted.Patients receiving kidney transplantation were given low dose immunosuppressants since 2000.Immunosuppressants including tacrolimus,MMF and Pred were adopted in some patients since 2000.Risk factors leading to graft loss and patients'death were analyzed.Results Until the cut date of June 30,2009,135 patients lost follow-up,and the follow-up rate was 94.6%.Incidence of acute(within 6 months post-transplantation) rejection was 18% among 2520 patients.Incidence of acute rejection (within 6 months post-transplantation) was 25.7% in panel reactive antibody (PRA) positive patients,significantly higher than 17.0% in PRA negative patients(P<0.05).Incidence of acute rejection within 6 months post-transplantation was 16.9% in HLA mismatches<4 patients,significantly lower than 23.7% in HLA≥4 patients (P<0.01).Total patient/death censored graft 1-,3-,5- and 1O-year survivals were 94.5%/96.0%,91.6%/93.1%,88.5%/90.1% and 81.7%/80.6%,respectively.Acute rejection and immunosuppressant regimen were independent risks for allograft loss.1mmunosuppressant regiment,pulmonary infection,cardio-brain-vessel accident, hepatic failure and tumor were independent risks for patients' death.Conclusion Renal allograft and patient survival appeared to be improved by optimal immunosuppressant regimen,strict HLA match and efficient post-transplant complication prophylaxis.