Objective To analyze complications of carotid artery stenting (CAS) and preventions.Methods Clinical data and treatment outcomes of 72 consecutive patients ( 80 stents ) from July 2006 to January 2012 with carotid stenosis were analyzed.Asprin 100 mg and clopedigrel 75 mg were given orally 5 days before CAS.Distal embolic protection device were implanted in all patients,pre-dilatation was done for those with carotid stenosis ＞ 90％ and post-dilatation was done for those of residual stenesis ＞ 30％.Severe complications of CAS mean death,myocardial infarction (MI) and stroke.Other minom included transient ischemic attack ( TIA ),hyperperfusion and intracranial hemorrhage ( ICH ),bradycardia and/or hypotension,hypertension,access hematoma or bleeding.Results In 72 patients a total of 80 self-expandable bare stents were successfully implanted.Distal embolic protection devices were used in all cases.Combined procedure was taken in 5 cases including OPCABG in 2 cases,left subclavain artery stenting in 2 cases and renal artery stenting in 1 case.The overall in-hospital complications was 37.5％ (27 of 72).Of these events,1 case had minor strokes defined as a modified Rankin Scale score less than 3 at 1-year follow-up,2 patients (2.78％ ) experienced a hemispheric TIA (neurological symptoms that resolved within 24 hours),1 patient experienced hyperperfusion syndrome.The overall mortality rate was 0,21 cases (29.2％ ) experienced hemodynamic instability (hypotension in 15 cases,bradycardia in 5 cases and hypertension in 1 case) and 2 others had access hematoms.The 30-day death/stroke/myocardial infarction risk was 1.39％ (1 minor stroke).Conclusions Hemedynamic instability (hypotension and bredycardia) is main complications of carotid artery stenting in patients with carotid artery stenosis,severe complications are rare.

Objective To investigate effect of sorafenib on serum hepatoma marker in patients with advanced hepatocellular carcinoma. Methods 101 patients with advanced hepatocellular carcinoma were selected, and divided into two groups.50 cases in control group were treated with routine clinical treatment, and 51 cases in experimental group were treated with sorafenib on the basis of control group.The survival time, adverse reactions, VEGF, CTGF, HIF-1 and OPN levels were compared after the treatment.Results The survival time of experimental group was higher than control group (P<0.05).Compared with control group, the serum levels of VEGF、CTGF,HIF-1, OPN,AFP, CEA, and CA199 in experiment group were lower (P<0.05,P <0.01).There were no significant differences of total adverse reactions between experimental group and control group. Conclusion Sorafenib can effectively prolong survival time of patients with advanced hepatocellular carcinoma, reduce serum VEGF, CTGF, HIF-1 alpha and OPN levels.

Objective To study the relationship of expression of angiopoietin gene and angiogenesis in the in-situ implanted hepatoma in rats. Methods Forty Wistar rats were used to establish the in-situ implanted hepatoma model by implanting Walker256 hepatoma cell line. The number of microvessel density(MVD) in hepatoma was calculated . The expression of angiopoietin mRNA was observed by in-situ hybridization method. Results The MDV in the implanted hepatoma in the first day of 1, 2 and 3 week postimplantatively were (15?4.3)/Hp,(17?3.6)/Hp,(45?7.8)/Hp respectively. The amount of MDV and expression of Ang-1 mRNA were increased significantly and correlated with MDV in the hepatoma tissues and non-hepatoma tissues,and no significant difference between the two types of tissues. Expression of Ang-2 mRNA was not seen in non-hepatoma tissues,but in hepatoma tissues,the expression of Ang-2 was obvious. Conclusions Angiopoietin-2 mRNA may play a role in the angiogenesis of the in-situ implanted hepatoma.

Objective To analyse the clinical features in general paresis of insane(GPI)as to offering an early diagnosis. Methods A retrospective analysis of 2 cases of GPI was focused on their clinical manifestations. Results The clinical features of GPI showed: (1) Chronic onset, progressive development in 2 cases; (2) Dementia was key symptom.Hasegawa dementia scales were 4 and 17 in 2 cases.2 cases accompanied with abnormal mentality,such as delusion of grandeur ,euphoria and so on;(3)GPI have features of pupil change,dysarthria,muscular tension,abnormal reflection; (4) Serum and cerebrospinal fluid (CSF) syphilis antibody reaction manifested positive, CSF protein content was increased significantly, and cells increased ( with lymph cell mainly ); (5) Head MRI manifested: cerebral atrophy in 2 cases, multiple abnormal signals in cerebral parenchyma in 1 case. Conclusions GPI misdiagnosis rate is high. Important basis of diagnosis remains on clinical manifestations, laboratory and imaging examinations.

Effects of traditional Chinese medicine salvianolate combined with alprostadil and reduced glutathione on delay of progression in patients with acute kidney injury has been confirmed, but the role of this combination therapy on the progression of chronic renal failure is uncertain.

Objective To improve differential diagnosis between acute disseminated encephalomyelitis ( ADEM) and classical multiple sclerosis ( CMS).Methods All 20 cases of ADEM and 24 cases of CMS were examined.Their epidemiological and clinical findings,laboratory features and magnetic resonance imaging ( MRI) data were analyzed using x2 test for categorical variables,Wilcoxon Rank-Sum tests for continuous variables.Results ADEM and CMS showed no sex predominance.Patients with ADEM ((27 ±15) years) were younger than CMS ((37 ±13) years,Z= -2.218,P =0.027).The following findings were more commonly seen in ADEM compared with CMS:predemyelinating infectious disease (75% vs 4%,x2 =23.652,P = 0.000),fever (65% vs 4%,x2 =18.609,P = 0.000),meningeal irritation sign (40% vs 0,x2 = 9.189,P =0.002),seizure (25% vs 0,x2 =4.514,P = 0.034),and encephalopathy.ADEM patients were more likely to present with blood leucocytosis ( (11.9 ± 5.8) ×109/L vs (8.0±3.2) ×109/L,Z= -2.030,P=0.042),high C-reactive protein (2.74 mg/L vs 0.49 mg/L,Z = - 3.028,P = 0.002),increased erythrocyte sedimentation rate (11.00 mm/h vs 7.00 mm/h,Z= -2.406,P =0.016),and cerebrospinal fluid leucocytosis (9 × 106/L vs 2×106/L,Z =- 2.781,P = 0.005).There were no differences in cerebrospinal fluid protein and oligoclonal band between the two groups.The following MRI lesions were more commonly seen in ADEM patients:cortical gray matter lesions (14/20,x2=15.213,P=0.000),basal ganglia gray matter lesions (14/20,x2 =8.910,P = 0.003),and brainstem lesions ( 14/20,x2 = 5.867,P = 0.015).In contrast,lesions in subcortical white matter (21/24,x2 = 17.628,P =0.000),periventricular area (21/24,x2 =15.213,P=0.000) and corpus callosum ( 14/24,x2 = 8.640,P = 0.003 ) were more common in the MRI image of CMS patients.The lesions in spinal cord were usually centrally distributed in ADEM (83% ),while peripherally in CMS (85%,x2 = 11.542,P = 0.001).The lesions had poorly defined margins in ADEM (95%),but well defined margins in CMS (75%,x2 =21.787,P = 0.000).Conclusion There are differences in epidemiological and clinical findings,laboratory features and MRI appearances between ADEM and CMS.

Objective To investigate the clinical features of pedistric Littre hernia.Methods Clinical data of 11 cases of Littre hermia admitted from January 2002 to December 2010 was studied retrospectively.Results The diagnosis of Littre hernia was all established by laparotomy.All of the 11 cases were boys,the median age was 1.2 years (22 days to 3 years and 7 months).The main clinical features were:painful,irregular and nonresetable mass in the groin area (11/11),vomiting in 6 cases (6/11 ),fever (＞38.5 ℃ ) in 4 cases (4/11 );X-ray showed intestinal obstruction in 9 cases (9/11 ),Ultrasound found mixed mass in the groin area in 11 cases ( 11/11 ),pouch-like structure were found in 6 cases (6/11).Eight cases (8/11) presented with elevated WBC ( ＞ 10000).Palpable lobulated structure were fell in 5 cases (5/11).All cases of Littre hernia were successfully operated on,Meckel diverticulum perforation was found in 2 cases ( 2/11 ),Meckel diverticulum adhered to the hernia sac in 8 eases (8/11).All patients were cured by surgery,and postoperative follow-up (10ms-8y) found no recurrence.Conclusions Pediatric Littre hernia is rare,preoperative diagnosis is difficult.Avoiding preoperative violent reduction and intraoperative injuring Meekel's diverticulum or the small bowel helps improve the cure rate of Littre hernia in children.

Objective To investigate the associations of aquaporin-4 (AQP4) promoter polymorphisms with anti-AQP4 antibody and genetic susceptibility to multiple sclerosis (MS) and neuromyelitis optica (NMO) in Southern Chinese population.Methods The polymorphisms of AQP4promoter 0 and 1 were analyzed by PCR and DNA sequencing in 18 NMO,38 MS,13 recurrent myelitis (RM),6 recurrent optic neuritis (RON)patients and 39 healthy controls. Results Fourteen polymorphism loci were observed in AQP4-promoter 0,while 6 ones were observed in AQP4-promoter 1.Among them,the incidence rate of polymorphism at position - 1003 bp (A-G) of AQP4-promoter 0 in anti-AQP4 antibody-positive patients was significantly higher than that in anti-AQP4 antibody-negative patients and controls (former:13/18 vs 20/45,P =0.046; latter:13/18 vs 10/39,P =0.001 ).The incidence rates of polymorphism at position between -401 bp and -400 bp ( C inserted) of AQP4-promoter 1 in anti-AQP4 antibody-positive and -negative patients were significantly higher than that in controls( former:5/16 vs 0/28,P =0.008; latter:8/38 vs 0/28,P =0.027 ). The incidence rates of polymorphism at position - 1003 bp (A-G) of AQP4-promoter 0 and position between -401 bp and -400 bp ( C inserted)of AQP4-promoter 1 in patients with NMO and MS were significantly higher than that in controls( NMO:11/18 vs 10/39,P =0.010;4/15 vs 0/28,P =0.020; MS:19/38 vs 10/39,P =0.027;8/34 vs 0/28,P =0.018).Conclusions Polymorphisms loci were observed in AQP4-promoter 0 and AQP4-promoter 1,which may have an influence on the susceptibility to MS and NMO.Polymorphism at position - 1003 bp ( A-G) of AQP4-promoter 0 may be related to the emergence of anti-AQP4 antibody in patients with NMO and MS.

Objective To identify the risk factors for early postoperative cognitive dysfunction (POCD) in the elderly patients undergoing spinal surgery.Methods One hundred and fifty ASA Ⅱ or Ⅲ patients,aged ≥65 yr,undergoing elective spinal surgery under general anesthesia,were studied.Venous blood samples were taken at 1 day before operation and 7 days after operation to determine the concentration of serum S-100B protein.Cognitive function was assessed by Mini-Mental State Examination (MMSE) at 1 day before operation and 7 days after operation.The patients were diagnosed as having POCD if MMSEpre-MMSEpost ≥ 3.The patients were divided into POCD group and non-POCD group.Age,body weight,sex,education,type of operations,complications,preoperative TCM syndrome type,MMSE score at 1 day before operation and 7 days after operation,duration of operation,emergence time,and intraoperative blood loss,cardiovascular events,and amount of fluid infused per hour were recorded.The risk factors for POCD were analyzed using multivariate logistic regression analysis.Results Thirty-eight patients developed early POCD (25.3％).The resuhs of logistic regression analysis showed that age ≥ 70 yr,elementary education or below,duration of operation ≥5 b,and the number of hypotension occurred during operation≥3 were the risk factors for early POCD.Conclusion Age≥70 yr,elementary education or below,duration of operation ≥ 5 h,and the number of hypotension occurred during operation ≥ 3 are the risk factors for early POCD in the elderly patients undergoing spinal surgery.

ObjectiveTo observe the clinical effect of interventional embolization on hepatocellular carcinoma(HCC) with hepatic arterioportal shunts(APS) ,in the hope of improving patients' survival quality and time. MethodsTwenty-nine patients with HCC patients and APS after a successful PVA,steel coils embolization, all patients were given routine TACE therapy. The changes of gastrointestinal bleeding,ascites,diarrhea and aminotransferase were analyzed retrospectively. ResultsNineteen cases got successful embolization in the first time[achievement ratio 65.5％(19/29)]; 3 cases got recurrence after embolization [patency ratio 10.3％(3/29)],7 cases appeared new APS[incidence ratio 24.1％(7/29),5 cases were embolized 2 times, 2 cases were embolized 3 times]. The effective rate of gastrointestinal bleeding,diarrhoea,aacites were 91.7％ (11/12), 84.6％ ( 11/13 ), 83.3％ ( 15/18 ) respectively, which had significant difference between preoperative and postoperative condition. The survival rate of 3 months,6 months, 1 year,and 2 years after operation were 96.6％ (28/29),89.7％ (26/29),65.5％ (19/29),34.5％ (10/29). Conclusion Interventional therapy is a safe and effective treatment to HCC with APS.