Objective To explore the activity signs and clinical value of CT in evaluation of anti -tuberculosis chemotherapy in elderly patients with active tuberculosis.Methods Clinical and imaging data of 78 cases with elderly active tuberculosis were retrospectively analyzed.The changes of CT sign between bacterium negative and posi-tive,before and after chemotherapy were compared.Results The detection rates of ground glass opacity,thick -walled cavity in bacterium positive were 72.1% and 55.8%,which were significantly higher than those in bacterium negative 45.7% and 28.6%(P <0.05).Compared with before chemotherapy,the detection rates of ground glass opacity,tree -in -bud,thick -walled cavity,pulmonary consolidation,centrilobular nodule,lobular consolidation after chemotherapy were significantly reduced(P <0.05).The active CT signs of ground glass opacity,tree -in -bud were completely absorbed,and other signs were lapsed to non -active signs including cord -like shadow,thin -walled cav-ity,calcification,bronchia aggregation and circuity.Conclusion There is conversion rule of CT signs in elderly active pulmonary tuberculosis before and after anti -tuberculosis chemotherapy,and CT is helpful in the evaluation of anti -tuberculosis chemotherapy results of active tuberculosis.

Objective To discuss the operative methods,clinical effect and safety of endovascular stenting in treatment of upra-arch extra intracranial artery stenosis.Methods Symptomatic carotid artery stenosis ＞ 50％,or no symptomatic stenosis ＞ 75％ with upra-arch extra intracranial artery stenosis patients were treated by endovascular stenting,of all patients,85 cases with carotid artery stenosis,37 cases with vertebral artery stenosis,6 cases with subclavian artery stenosis.Results One hundred and twenty-eight patients were treated with 130 vessel,used 131 stents,59 patients used vascular protection,the achievement rate of stent implantation was 100.00％.The degree of stenosis were significantly improved,the degree of stenosis from (87.65 ± 8.70)％ to (14.28 ± 4.87)％.Twenty-six patients appeared transient decline in blood pressure and heart rate,31 patients appeared persistent hypotension and decrease in heart rate.One patient (no using of vascular protection) appeared obhteration in ipsilateral middle cerebral artery,the artery was recanalization after thrombolysis treatment.The rest of 127 patients did not appear intraoperative vascular embolization complications.Eighteen patients appeared perioperative perfusion in transition,1 case happened cerebral hemorrhage (＜ 10 ml).Postoperative symptoms were improved significantly.Followed up for 6-36 months,84 patients had not restenosis in stent,1 patient had symptomless restenosis (＜ 50％).In 37 patients with vertebral artery stenosis,3 patients again appeared ischemia symptoms in postoperative 1 year,digital subtraction angiography (DSA) showed restenosis in stent,the patient was again given endovascular stenting,the symptoms disappeared.Conclusion As long as the correct choice of indications and perioperative treatment properly,the endovascular stenting in treatment of upra-arch extra intracranial artery stenosis has good clinical effect and high security.

Objective:To investigate the effect and safety of sertraline tablets with oral administration in the diabetes patients com-plicated with depression. Methods:Totally 74 diabetes patients complicated with depression were randomly divided into 2 groups with 37 ones in each. All the patients were orally given dimethyldiguanide 500 mg,tid,and the observation group was given sertraline tablets additionally,50-100 mg,qd. The treatment course was 8 weeks. The changes of sugar metabolism and the scores of self-rating depres-sion scale( SDS)and quality of life scale( DMQLS)in the two groups were compared. Results:After the 8-week treatment,the blood sugar,SDS scores and DMQLS scores in the two groups were significantly improved when compared with those before the treatment( P<0. 05). The levels of FBG,2hPG and HbAlc and SDS scores in the observation group were significantly lower than those in the con-trol group(P<0. 05),while the scores of DMQLS disease,psychology,society and satisfaction dimension were significantly higher in the observation group(P<0. 05). The incidence of adverse reactions showed no statistically significant difference between the two groups(P>0. 05). Conclusion:Sertraline tablets can improve the depression of diabetes patients and enhance the blood sugar control and quality of life.

Objective To investigate the long-term effect of angioplasty of patients with symptomatic vertebrobasilar artery stent.Methods Thirty-three patients with symptomatic vertebral artery stenosis who underwent endovascular treatment stent.The clinical symptoms and stent restenosis were recorded.Results The clinical symptoms of 33 cases with angioplasty were improved significantly.The preoperative stenosis rate was (92.36 ±3.23)％ before operation and the average postoperative residual stenosis rate was (9.13 ±2.57)％ after operation.Clinical symptoms of 23 patients disappeared completely after operation,and 10 cases improved significantly.As to complications,1 case with severe basilar artery stenosis had a side numbness of extremities,1 case showed postoperative cerebral embolism,and return to normal after 3 days.When follow up periods lasted for 6-24 months,9 cases were with dizziness or other symptoms.Of which,29 cases were performed DSA imaging,the residual stenosis rate was (19.27 ± 5.62)％,3 cases of vertebral artery in-stent restenosis were reached over 50％.Those 3 cases were give stent angioplasty again and the uncomfortable symptoms disappeared.Conclusion Stenosis opeation can significantly alleviate the symptoms of cerebral ischemia and symptomatic vertebrobasilar artery,and improve the quality of life of patients.However,restenosis should paid more attention.

Objective To evaluate the safety and effect of mechanical thrombectomy with the stent device in posterior circulation large intracerebral artery occlusions.Methods Arterial embolectomy with the stent device was carried out in 16 patients with posterior circulation large intracerebral artery occlusions(3.5 h than intravenous thrombolysis time window)in the NO.264th Hospital of People Liberation Army,including 8 cases with pure basilar artery occlusion,7 cases with bilateral vertebral artery intracranial segment and basilar artery occlusion,1 case with side of intracranial vertebral artery occlusion.The National Institutes of health neurological deficit score(NIHSS)score,Alberta stroke program early CT(ASPECTS)score,complications,clinical result were analyzed retrospectively.Results Among 16 cases,the time windows were from 7 to 18 h,the time from onset to reperfusion were(13.32±1.57)h.Successful recanalization was obtained in 15 patients(TICI=3),partial recanalization in 1 case(TICI=2a).Three cases with stent angioplasty.Survival in patients with NIHSS score decreased from(24.65±3.63)points on admission to(4.32±1.57)points after three weeks,with statistical difference(P＜0.01).For mRs score at 90 d: 6 cases(37.5％)with 0-1,4 cases(25％)with 2-3,2 cases(12.5％)with 4-5,4 cases died(25.0％,score ASPECTS 4-5).Conclusion The mechanical thrombectomy with the stent device within 24 h can get higher reperfusion rate,fewer complications,and significantly reduce the mortality rate and good clinical outcome in large intracerebral poster circulation artery occlusions patients.

BACKGROUND: Human apolipoprotein H which characterizes by polymorphism is related to metabolism of triacylglycerol (TG) and function of platelet; therefore, it is suspected that it is possibly related to coronary atherosclerotic heart disease (CAHD).OBJECTIVE: To investigate the correlation among apolipoprotein H(ApoH) exon-8 polymorphism with CAHD and its effect on lipometabolism.DESIGN: Case-controlled observation.SETTING: Department of Cardiology, Haici Medical Group, Qingdao,Shangdong. PARTICIPANTS: 110 CAHD patients selected from Qingdao Haici Medical Group were regarded as CAHD group, and other 100 healthy subjects were regarded as control group.METHODS: 2 mL blood was collected from peripheral vein of all cases. Polymerase chain reaction and technique of restriction fragment length polymorphism were used to determine the genotype of ApoH exon-8; meanwhile, lipids were measured with oxidase technique.MAIN OUTCOME MEASURES: ① polymorphism of ApoH exon-8 genotype; ② gene frequency of ApoH exon-8 (Try316Ser); ③ comparisons of lipid level of cases with various genetypes.RESULTS: All 210 cases were involved in the final analysis. ① G1025C (Try316Ser) existed in ApoH exon-8, including types of GG and GC, butnot CC type. ② The frequency of GC in the CAHD group was 25.5％, and the frequency of C allele was 0.13; they were significantly higher than those in control group (10％, 0.05, P ＜0.05). ③ TG level in genotype GC of CAHD group was significantly higher than that both in GG genotype and in any genotype of control group [(1.38±0.24), (1.16±0.10),(1.09±0.78), (1.12±0.76) mmol/L, P ＜ 0.05]. Level of low-density lipoprotein cholesterol (C-LDL) was higher in CAHD group than that in control group (P＜0.05).CONCLUSION: The polymorphism of ApoH exon-8 is closely related to CAHD and TG level.

Objective To evaluate the safety and effectiveness of mechanical thrombectomy with Solitaire AB stent in the treatment of large intracranial artery occlusions.Methods The calinical data of 15 patients with acute stroke(more than 3.5 h intravenous thrombolysis time window) who were carried out arterial embolectomy with Solitaire AB stent in the No.264th Hospital of the Chinese People's Liberation Army were retrospective analyzed.There were 11 cases of middle cerebral artery(MCA),2 cases of internal carotid artery (ICA),1 case of vertebral artery(VA) pluse basilar artery(BA),and 1 case of anterior artery(AA).The recanalization occluded situation and surgical complications were analyzed,NIHSS score of preoperatively and at discharge were compared.Results In 15 cases,there were 14 cases of totally recanalization,1 case of partial recanalization.Two case with MCA stenosis and 1 case with VA stenosis after the recanalization were accepted stent angioplasty,2 csase died.NIHSS score of 13 cases survival patients increased from (22.85±4.75) scores on admission to (4.39 ±3.67) scores out of hospital,and the difference was statistically sinificant(t=2.752,P ＜0.01).Conclusion The mechanical thrombectomy with Solitaire AB stent can get high recanalization rate,fewer complications and good clinical outcome on patients with large intracranial artery occlusions.For more than venous or arterial thrombolysis time window,the mechanical thrombectomy can be considered within the 8 h after comprehensive evaluation.

A case of multiple keratoacanthoma centrifugum marginatum is first reported in China. A 37-year-old woman was admitted to the hospital for papules and plaques on her face, which had been increasing in number for 4 months. Cutaneous examination revealed dozenes of well-marginated, pale-red or skin-colored crateriform papules of variant size, and plaques in a geographic pattern on her face. The papules presented with a central umbilication filled with grey-brown corneous material. The plaques were surrounded by dyke-like borders, covered with thick, crusted brown corneous material, and partly depressed in the center. Histopathology showed hyperkeratosis, parakeratosis, irregular strip-like extension of epidermis into dermis, keratinous cysts and squamous eddies. The tumor cells had eosinophilic and glassy cytoplasm characteristic of keratoacanthoma.Given both the clinical and histologic evidence, a diagnosis of multiple keratoacanthoma centrifugum marginatum was made. After more than 3 months of treatment with oral acitretin and topical tretinoin, the lesions faded,leaving rugosity scars. No relapse was noted during 3-year follow-up.

The acute ischemic stroke has become the first major disability and death disease in China.With the release of the results of five trials represented by the Dutch multicenter randomized clinical trials of intravascular treatment of acute ischemic stroke, mechanical thrombectomy has become the main means to treat the acute ischemic stroke caused by the occlusion of large intracranial vessels, ushering in a new era of mechanical thrombectomy for acute cerebral infarction.At present, the main devices of mechanical thrombectomy are Merci thrombectomy device, penumbra thrombectomy device, solitairetm fr stent, revive se stent, trevo stent and aperio ® stent.According to the location and conditions of vascular embolism, different types of thrombectomy devices should be selected, and different thrombectomy technologies, such as adapt technology, solumbra Technology, advance technology, save technology, swim technology, etc So as to improve the recanalization rate and reduce complications.

Objective To investigate the effect of Solitaire stent combined with coils on endovascular embolization of intracranial wide-necked aneurysms.Methods Twenty-six cases with intracranial wide-necked aneurysms from June 2009 to December 2011 in the NO.264 Hospital of the Chinese People's Liberation Army were treated with Solitaire stent-assisted coils,and anticoagulation and antiplatelet therapy were done among peri operation period.The effect of endovascular embolization was evaluated after 3 months cerebral angiography.Results A total of 27 solitaire stent were used in the 26 patients,one of which used 2 stents.The stents were successfully put in place,and the placement effect were satisfaction.The immediate angiography showed that 24 cases were dense embolism,2 cases of subtotal embolization.Stent were placed at right position.Twenty-three patients were followed with DSA for 3 months,and no aneurysm evidence of recurrence was found.Conclusion Solitaire stent-assisted coil embolization of intracranial wide-necked aneurysms is simple to perform and embolism rate is high and the recurrence rate is low.