Objective To investigate the relationship between resting heart rate (RHR) and target organs damage (TOD) in senile metabolic syndrome(SMS). Methods With case-control study,215 elderly patients with MS were divided into 3 groups according to the level of RHR [RHR1 group: RHR <70 beats/ minute (bpm) (n=55);RHR2group: 70 bpm ≤RHR<80 bpm [n=87);RHR3 group: RHR≥80 bpm (n=73).Mean-while ,60 healthy senile persons were taken as normal control group. For all objects researched, electrocardiography, echocardiography,carotid ultrasonography, creatinine clearance rate (Ccr) and quantitative assay for 24 hours' urina-ry microalbuminuria (MAU) were performed. Part of SMS patients was examined by coronary angiography and com-puter tomography (CT) of head. Results ① Compared with normal control group, RHR groups showed higher lev-els of carotid intima-medial thickness (IMT), carotid arterial diameter (CAD), left ventricular mass index (LVMI) and MAU, lower levels of left ventricular ejection fraction (LVEF) and Ccr (P<0.05 or 0.01). With RHR increas-ing among RHR groups,IMT,CAD,LVMI,MAU and the score of coronary artery stenosis increased,and LVEF and Cer decreased (P<0.05 or 0.01). ② The levels of IMT, CAD, LVMI and MAU were positively correlated to RHR (r=0.34,0.25,0.62, and 0.57, respectively, P<0.05 or 0.01). However, the levels of LVEF and Ccr were nega-tively correlated to RHR (r=-0.60,-0.52 respectively,P<0.01). ③ Logistic multivariate analysis showed that RHR, pulse pressure (PP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) influenced TOD,such as myocardial hypertrophy,coronary heart disease,heart failure, cerebral stroke and renal damage in dif-ferent degrees, among them, PP and RHR played more important roles than those of other factors. Conclusion RHR may be an independent risk factors of TOD in senile MS. It is indicated that RHR regulation is important for the de-velopment of senile MS.

[Objective]To discuss the postoperative effect of the posteromedial structure injury (medial collateral ligament,MCL,posterior oblique ligament,POL) of the knee.[Method]Fourteen cases of complex posteromedial structure injury were treated from January 2002 to October 2007,twelve of which combined with ACL injury and two combined with PCL injury.Classification of posteromedial structure injury:typeⅠ,8 cases,ruptured from the femur with small bone fragment;type Ⅱ,2 cases,ruptured from the femur without bone fragment;typeⅢ,2 cases,the structure were torn from the body area,and type Ⅳ,2 cases,ruptured from the tibia.The injury were repaired by different techniques according to the classification.Eight cases applied star-shaped steel plate,four with GⅡ anchor screws(2 attached to the femur and 2 to the tibia adhesion respectively),and 2 cases with end-to-end suture.The ruptured ACL and PCL were reconstructed by arthroscopy.Autologous semitendinosus and gracilis were used for 8 ACL reconstruction and B-T-B technique for the other two ACL reconstruction.Two ruptured PCL were reconstructed with allograft of Achilles tendon.[Result]All cases were followed up for twelve months at average(6-18 months) except two cases only for four months.The functional score of the knees were improved from 56.7(50-60) preoperatively to 81.2(74-94) postoperatively in average valued by Lysholm system.Ten cases received normal knee flexion and extension range after repair of the posteromedial structure while 2 cases with restricted 5 degree extension.Nine cases received excellent result in lateral stress test while 2 cases with "+" and 1 case with "++" at zero angle.[Conclusion]Early repaire for the posteromedial structure injury will deliver excellent knee stability.

Objective To discuss the implications of orbital septum repairing and crimpling in the plastic surgery of lower eyelid bags. Methods The ultimate results were analyzed in the patients (aged less than 40) who received three different operations from six months to five years and the effect of operation and recrudescence of lower eyelid sag were observed. The procedures included simple fat removal, fat removal plus orbicularis oculi hanging, and orbicularis oculi hanging plus orbital septum repairing and crimplling. Results Since 2002, 157 cases were treated, and the ultimate effects of patients were analyzed. 86 cases treated with orbicularis oculi hanging plus orbital septum repairing and crimplling reached the best results without recurrence. 71 cases treated with simple fat removal or fat removal plus orbicularis oculi hanging experienced recurrence in different degree within a short period. Conclusion The weakness and laxation of the former wall causes the formation of lower eyelid bag, the appearance and recrudescence mainly locate below the former wall. Orbital septum repairing and crimpling most effectively strengthen the underside of the former wall. Orbicularis oculi hanging strengthens the top of the former wall and prevents any complications. The effects of the last procedure are better than that of the other two in the near future or in the long term.

Objective It is controversial to the surgical treatment of the DeBakey I aortic dissection.The purpose of the study was to summarize the clinical experience on total arch replacement combined with implantation of stented elephant trunk into the descending aorta for DeBakey I aortic dissection.Methods From June 2005 to March 2008,41 consecutive patients with acute(in 31)or chronic(in 10)DeBakey I aortic dissection underwent total arch replacement combined with implantation of stented elephant trunk into the descending aorta.The mean age was 57(27～76)years.Thirty-two patients were male.The procedure was performed under deep hypothermic circulatory arrest and selected cerebral perfusion.The stented elephant trunk was implanted through the aortic arch under deep hypothermic circulatory arrest.The stented elephant trunk was an 8～10 cm long self-expandable graft.Concomitant procedures included Bentall operation and total arch replacement in 24,Wheat operation and total arch replacement in 6,ascending aorta and total arch replacement in 11.Computed tomography was performed in every patient before discharge to evaluate the postoperative outcomes of the procedure.Results Cardiopulmonary bypass time was(168±32)min.The cross clamp time was(109±24)min and selective cerebral perfusion and the lowerbody circulatory arrest time wsa(31±11)min.The in-hospital mortality was 4.9%(2/41).One patient died of hemorrhagic shock and another died of multi-organ failure postoperatively.Fourteen cases suffered complications and 12 cases were cured.One case died of the cerebral hemorrhage after 4 months due to inappropriate anticoagulation during follow up.Conclusion Ascending aorta and total aortic arch replacement combined with implantation of stented trunk into descending aorta is a safe,effective and feasible way in closing the residual false lumen of the descending aorta with a low morbidity and mortality.This procedure might contribute to a better long-term outcomes of DeBakey I aortic dissection.

There are two phenotypes of microglia, M1 and M2. Microglia in M2 polarization may associate with the phagorytosis of be-ta-amyloid and inhibition of Tau hyperphosphorylation, as well as in other pathology. Electroacupuncture can impact the phenotypes of mi-croglia, which may play a role in the treatment for Alzheimer's disease.

Objective To explore the relationship between the typing of lower eyelid bag and surgical procedures and their clinical efficacy. Methods The eyelid bag was divided into three types and seven subtypes according to the clinical manifestation in 216 cases. Congenital structural abnoma-lities caused type Ⅰ of lower eyelid bag, long-term ophthalmokopia caused type Ⅱ of lower eyelid bag. Anaplasia of tissue and bone caused type Ⅲ of lower eyelid bag. Seven surgical methods were per-formed for lower eyelid blepharoplasty by various type. Results 159 of 216 cases were followed-up for 3 - 12 months, and most of the patients had excellent clinical results. Conclusion This simple typing is valuable for adopting surgical methods.

The structure and 5-HT immunoreactivity in the brain and suboesophageal ganglion of three beetles, Ambrostoma quadriimpressum, Henosepilachna vigintioctomaculata and Oxycetonia jucunda, were first studied by means of colophony-paraffin embedding serial section technique and strepteavidin-peroxidase immunohistochemical method. The results showed that the brains of these three taxonomically closely related beetles were remarkably different in composition and size. Mushroom bodies and antennal lobes in Oxycetonia jucunda were conspicuous. Calyces and lobes of the mushroom bodies.were much developed. In contrast, calyces of Ambrostoma quadriimpressum and Henosepilachna vigintioctomaculata were extremely undeveloped. However, the postretinal fibres and circumpharyngeal nerves of Ambrostoma quadriimpressum were highly developed. In the three beetles, 5-HT immunoreactivity was present in all neuropils of the brain and the suboesophageal ganglion. The pattern of 5-HT immunoreactivity and the localization of immunoreactive somata which often clustered into groups were similar among these beetles, while the immunoreactivity intensity was distinct, especially in the lamina. The results suggest that the three beetles have given rise to adaptive radiation under the evolutionary pressure because of the long-term different life styles and living environments in which the taxonomic status of Ambrostoma quadriimpressum is relatively low. The similarity of the pattern of 5-HT immunoreactivity and localization of some positive somata among the three beetles raise the possibility that 5-HT seemes to serve similar physiological function in different insects. Furthermore, 5-HT might be involved in modulating the ingestion by regulating muscular activity and visual sensitivity.

Objective To discuss the reduction mammaplasty procedures by reserving the T4 nerve and blood vessels and by repairing the ligament for macromastia patients. Meths Eighteen cases of macromastia were enrolled in this study. The supeior and inferior polar portions on the median line of the breast were dissected to form a central pedicle. Outside deep and fleet branches of the ligament were repaired and the lateral deep and fleet branches of the 4th intercostal nerve reserved in the pedicle. The pedicle was revolved and fixed, the fundus of breast was reduced and the tensile force of the ligament was enhanced. The operation of two-flap rotated flaps reduced the breast volume from inside to the outside. The corium where T4 intercostal nerve distributed skin was reserved to protect the fleet branches of the nerve, and then rotated and fixed to act as a fibrous septum. Results After the operation, the blood vessel and feeling of nipple-areola complex were all satisfactory and the profile of breast was tall and straight. Follow-up from 3 months to 2 years (7 months in average) showed that the scar was unconspicuous, the appearance of the breast was not evidently changed and the patients were satisfactory. Conclusion It is a simple and well-designed procedure of reduction mammaplasty for macromastia with repaired ligment and reserved 4th intercostal nerve. The breast profile is tall and straight after the operation.

Objective The analysis of correlation between the occurrence of tourette syndrome with one-child family environment. Methods The authors investigated home environment of two groups. One group included 200 patients with tourette syndrome and is the other group included healthy children of the same age in 3 different primary and secondary schools. By comparing with the home environmental factors, parenting styles and parent emotional factors between two groups. Results The instabilities of home environment included bad family relationship, separation between parents, divorce, scolding and even beating children. It showed that anxiety of the direct supervisors among the sickness group were higher than healthy control group as well. Among the ten factors of the Family Environments Scale, the significant differences showed in six factors of affection,cohesion,expressiveness, conflict, intellectual-culture orientation, active-recreational orientation, organization between the two groups. Conclusion So we concluded that ①There is a correlation between the parents relations,parenting styles and the incidence of tourette syndrome; ②An anxiety of the direct supervisor may initiate, even aggravate the incidence of tourette syndrome; ③It is important to convert the education mode and take family overall treatment in order to reduce the incidence and improve the effectiveness of tourette syndrome.

BACKGROUND:B cell activating factor belonging to tumor necrosis factor family(BAFF)is essential to B cell differentiation,maturation,survival,and antibody secretion via binding to its receptors,and may play a role in the development of T cell response.Whether or not BAFF signal participates in the kidney allograft rejection is worthy of studying.OBJECTIVE:To analyze the expression and potential bioactivity of BAFF in the peripheral lymphocytes of kidney transplant recipients.DESIGN,TIME AND SETTING:A case observation was performed at the Department of Urology,Third Affiliated Hospital of Soochow University from June 2006 to March 2007.PARTICIPANTS:Eighty-six kidney transplant recipients comprising 60 males and 26 females,aged 12-62 years old,who received first-time kidney transplantation,were included.The serum creatinine levels ranged between 65-267 μmol/L.METHODS:Peripheral blood of follow-up recipients was taken for anticoagulation using EDTA-Na2.Renal graft biopsy samples of some patients were collected.MAIN OUTCOME MEASURES:The expression rates of BAFF+,BAFF-R+,CD4+,CD8+,CD4+ CD25+ CD127-/low,CD134+,CD4+ CD 134+ and CD19+ BAFF-R+ in peripheral mononuclear cells were analyzed,and the ratio of CD4/CD8 was calculated.Biopsy tissue was subjected to pathological and immunohistochemical analyses.RESULTS:BAFF expression rate on the peripheral mononuclear cells was between 0.18%-76.97%.15%was used as the cut-off value.In the ≥15%group,the mean value of BAFF expression rate was 36.91%;BAFF+ mononuclear cells were not significantly correlated to the ratio of peripheral CD4+/CD8+ and the CD4+ CD25+ CD127-/low T lymphocytes.However,there were significant correlations between BAFF+ mononuclear cells and CD134+ lymphocytes or CD4+ CD134+ lymphocytes(P ＜0.01,P ＜0.05,respectively).While in the ＜15%group,there were no significant correlations among all indices.Pathological diagnosis confirmed that BAFF was expressed in the renal tubular epithelial cell cytoplasm and cytomembrane staining of some chronic rejection sections.CONCLUSION:Abnormal high expression of BAFF in peripheral mononuclear cells may be related to renal allograft rejection.