Objective To evaluate the relation between cystatin C and the presence and severity of asymptomatic coronary artery disease in metabolic syndrome(MetS).Methods A total of 201 asymptomatic MetS patients with normal renal function were per-formed the coronary angiograph and the detection of serum Cystatin C level and other risk factors for atherosclerosis.Results Ser-um cystatin C level in the MetS patients with asymptomatic coronary artery disease were significantly higher than those in the pa-tients without coronary artery disease,moreover the more severe of the disease,the higher the cyctatin C,which was independently associated with other risk factors for atherosclerosis.Conclusion Serum cystatin C level can been used as the index for the presence and severity of asymptomatic coronary artery disease in Mets with normal kidney function.

Objective To assess the diagnostic value of mammography,ultrasound and 18F-fluorodeoxyglucose(18F-FDG) dual-head coincidence(DHC) imaging in the detection of primary breast cancer. Methods The results of 54 female patients with 57 breast lesion sites examined by mammography,ultrasound and 18F-FDG dual-head coincidence(DHC) imaging were analysed and compared with pathologic findings.The sensitivity of mammography was compared with combined mammography with ultrasound or triple-tests,and the sensitivity of 18F-FDG DHC imaging was compared with combined mammography and ultrasound. Results The individual sensitivities of mammography,ultrasound and 18F-FDG DHC imaging in the diagnosis of primary breast cancer were 89.13%,91.30% and 91.30%,respectively,those for specificities were 72.73%,72.73% and 63.64%,respectively,and those for accuracies were 85.96%,87.72% and 85.96%,respectively.The sensitivity,specificity and accuracy of combined mammography with ultrasound were 100%,63.64% and 92.98%,respectively,and those of triple-tests were 97.83%,81.82% and 94.74%,respectively.Combined mammography with ultrasound and triple-tests were more sensitive than mammography(P0.05).Triple-tests were more sensitive than combined mammography with ultrasound(P

Objective To explore the surgical management for arterial diseases. Methods The clinical data of 86 cases of arterial diseases were analysed retrospectively. These cases included:3 cases of thoracic aortic aneurysm,2 cases of descending aortic dissection with rupture and aneurysm formation,2 cases of abdominal aortic dissection with false aneurysm,1 case of abdominal aortic aneurysm(AAA)with duodenojejunal fistula and GI bleeding,5 cases of ruptured AAA with shock, 3 cases of traumatic rupture of abdominal aorta,21 cases of AAA combined with unilateral or bilateral iliac aneurysms,6 cases of iliac aneurysms,9 cases of popliteal aneurysms,21 cases of false aneurysm of iliac or popliteal artery,1 case of rupture of junction of subclavian and vertebral artery with false aneurysm,3 cases of rupture of subclavian artery with false aneurysm,2 cases of aneurysm of carotid artery and 7 cases of false aneurysm of carotid artery. Prosthetic vascular graft was performed in 71(cases),autologous vein graft in 3 cases and suture(repair) of arterial rupture in 12 cases.Results Operative (mortalty) was 3.5%(3/86)in this series.Seventy-one cases were followed-up for 1 month to 5 years, the results showed that all the patients were alive and well.Conclusions In the(management) of(appropriate) aortic diseases, the use of endoluminal technique is simple, microtraumtic, safe and has few complications. It also can shorten the hospital stay of the patient. Endovascular technique should be the first choice for patients with aortic diseases.

Objective To evaluate endoluminal repair and preoperative management for acute Standford type B aortic dissection complicating massive hydrothorax. Methods The clinical data of 27 patients (23 males, 4 females) hospitalized from January 2003 to December 2008 were analysed retrospectively. The average age was 47 ±9 years (35 ～70). Eleven patients had bilateral huge hydrothorax (40. 7% ) , while 13 had left hydrothorax (48. 1% ) and 3 had right hydrothorax (11. 1% ) only, and in 2 of them with additional pericardial effusion (7.4% ). SaO2 was below 90% in all cases. All patients underwent emergency endovascular repair. For control of massive hydrothorax found by CT or chest fluoroscopy, puncture drainage or tube drainage were administrated postoperatively. Results All the 27 operations were successful, and there was no perioperative mortality. Three type Ⅰ and one type Ⅳ endoleaks occurred but disappeared in one month. Hydrothorax disappeared 28 days to 3 months postoperatively in all patients, of which 5 cases had puncture drainage (18.5%) and 1 case had tube drainage ( 3. 7% ). Mean follow-up was 30 ± 20 m ( 6 ～ 78 m ) after endovascular management. Complications included pleural thickening (6 of 27, 22. 2% ) , pulmonary atelectasis (2 of 27, 7. 4% ) , and lung consolidation combined with chest dent (2 of 27, 7. 4% ). Conclusions Emergency endovascular therapy is safe and effective for acute Stanford type B aortic dissection with massive hydrothorax. Drainage of hydrothorax after stent-graft deployment is a must for the patient suffering from severe respiratory failure.

Objective To investigate the clinical value of high resolution ultrasound combined with radiological imaging in the diagnosis of Meckel′s diverticulitis (MD),and to analyze the causes of missed diagnosis as well as misdiagnosis by ultrasound.Methods The image data of 61 patients with MD were retrospectively analyzed,the essentials and the causes of missed diagnosis as well as misdiagnosis of ultrasound were summarized and compared with the results of operation,CT,gastrointestinal contrast,as well as radionuclide.Results The patients were divided into simple type(18,29.5%) and complex type(43,70.5%) according to ultrasonography.The simple type diagnostic accuracy rate was 100%,the ultrasonography showed the right lower abdominal tubular bowel shadow or cystic echo mass,and the structure of diverticulum could clearly showed by ultrasound.In another side,the complex type diagnostic accuracy rate was 55.8%,the ultrasonography showed the right lower abdominal mixed echo mass or concomitant with other alimentary tract malformation,while the diverticulum structure was difficult to be distinguished.The diagnostic accuracy rate of radionuclide imaging was 83.6%,CT was 37.0%,while gastrointestinal contrast was 30.0%.Among 19 cases of misdiagnosis by ultrasound,13 cases of MD were confirmed by radionuclide and CT examination,the diagnostic accuracy rate of ultrasound combined with radiological imaging diagnosis was 90.2%.Conclusions The sonographic features of MD are lack of specificity,especially in the complex type,while the patients with recurrent hemafecia or acute abdomen should be alert to the presence of MD.Patients who are suspected of MD by ultrasound diagnosis should also be examined by radiological imaging in order to make an early diagnosis and surgical treatment to improve the prognosis of patients.

Objective To discuss the risks of hypertension development with relation to the level of lipid variables among populations who had normal blood pressure at baseline study. Methods In April 2000, under the support of project "prevention of metabolic syndrome and multi-metabolic disorders in Jiangsu province", a cohort study was performed to obtain the baseline data among 8685 persons from age 34 to 74. In June of 2006, a follow-up investigation was carried out among those who had been in the study for 5 years after the baseline study started. 2603 persons who met the selection criteria and showed normal blood pressure during baseline study, were recruited in this investigation. The interval from the baseline to the follow-up studies was 6.38 years on average. Relationship between the risk of developing hypertension and the baseline level of lipid variables were analyzed. Results Relations between baseline lipid levels and the incidence of hypertension during the follow-up was discovered. In gender and age adjusted model, the lipid variables were all associated with hypertension(Wend test, P<0.01). In multivariable-adjusted model, HDL-C [aRR=0.71 (95%CI: 0.61-0.99)], non-HDL-C [αRR=1.28 (95%CI: 1.14-1.83)], TC/HDL-C ratio[aRR=1.41 (95%CI: 1.25-2.03)] and TG [αRR=1.49(95%CI: 1.30-2.13)] were again associated with hypertension (trend test, P<0.05). Even the αRR was much weakened after the baseline SBP, DBP were adjusted with Cox model, the significant relation of hypertension to HDL-C, TC/HDL-C ratio and TG still existed. Excluding the two factors of obesity (BMI≥28) and diabetes which had been recognized in marked linking with hypertension, lipid variables were still associated with hypertension. Conclusion Dyslipidemia might occur before being hypertensive. Hypertension was associated with HDL-C, TC/HDL-C and TG or even exclusion of obesity, diabetes and factors of smoking and drinking or baseline level of SBP, DBP were adjusted.

Objective To compare metabolic syndrome(MS)score with the 10-year-Framingham risk score(FRS)to predict the occurrence of cardiovascular disease(CVD).Methods MS score for prediction of CVD was developed based on the 10-year FRS.Cox proportional hazard model and receiver-operating characteristic(ROC)curves were used to compare the predictive effects,based on data from a cohort study on the prevention of multiple metabolic disorders and MS in Jiangsu province.Results Area under the curve(AUC)increased after changing MS components into continuous variables.AUC of MS score/MS components aggregation was 0.70/0.65,P＜0.05 and sensitivity of MS score/MS components aggregation was 80.5%/74.4% for a given specificity.After mutually adjusted risk factors of MS score and the FRS,when age was exclusively excluded,AUC of the FRS decreased from 0.78 to 0.65(P＜0.05).However,when age was included,the AUC of MS score increased to 0.78(sensitivity of MS score including the age/the FRS:90.2% vs.87.8 %);In Cox proportional hazards multiple risk factors analysis,MS score including age appeared greater association with CVD than FRS on the same exposed subjects.Conclusion The new developed MS score with age included was a valid tool for predicting CVD and its predictive ability was as good as the FRS.

Objective　To investigate the role of cytotoxic T lymphocyte associated molecule-4Ig(CTLA-4Ig) in the prevention of C57BL/6 mice autoimmune hepatitis. Methods　The C57BL/6 mice were intraperitoneally immunized with C57BL/6 mice liver-specific protein in complete Freund's adjuvant. At the same time CTLA-4Ig were given to observe the pathologic alteration of C57BL/6 mice liver. Results　With the increase of time of immunization, the results in the treatment group were similar to those of the control group; but inflammatory cell infiltration, hepatic cell swelling, focal necrosis and severe hepatocyte damage were found in the pathologic model group. There was a significant difference between the pathologic model group and control one. Conclusion　Autoimmune hepatitis of C57BL/6 mice can be effectively prevented by CTLA-4Ig.

Objective To investigate the association between ten single nucleotide polymorphism (SNP) in the peroxisome proliferator-aetivated receptor (PPAR) α/δ/γ and essential hypertension (EH).Methods Participants were recruited within the framework of a cohort populations survey from the PMMJS (Prevention of Multiple Metabolic Disorders and MS in Jiangsu Province) which was conducted in the urban community of Jiangsu province from 1999 to 2007.Eight handred and twenty subjects (551 non-hypertensive subjects,269 hypertensive subjects) were randomly selected but were not related to each other.Ten SN P ( rs 135539,rs1800206,rs4253778 of PPAR αt; rs2016520,rs9794 of PPARδ ; rs10865710,rs1805192,rs4684847,rs709158 and rs3856806 of PPARγ ) were selected from the HapMap database.x2 test was used to determine whether the whole population was in H-W genetic equilibrium.SHEsis software was used to examine the relations of SNP and linkage equilibrium.Logistic regression model was used to examine the association between ten SNP in the PPAR and EH.Results Difference on the distribution of four SNP genotypes including rs1800206,rs9794,rsl0865710 and rs4684847 between high blood pressure and non-high blood pressure group,high systolic blood pressure(SBP) and normal SBP group,high diastolic blood pressure(DBP) and normal DBP group was significant (P＜0.05).After adjusting factors as age,sex,body mass index,fasting plasma glucose,high density lipoprotein cholesterol-C,high-fat diet and compared with wildtype gene carriers,the OR(95％ CI) of objects with rs1800206 V allele appeared in high blood pressure,high SBP and high DBP were 0.60 (0A1-0.89),0.57 (0.37-0.88) and 0.61 (0.39-0.96),respectively.The OR(95％CI) of objects with G allele of rs9794 were 0.63 (0.46-0.87),0.51 (0.36-0.73) and 0.68(0.47-1.01).The OR (95％CI) of objects with G allele of rs10865710 were 1.62 (1.19-2.20),1.59(1.14-2.22) and 1.53 ( 1.07-2.18),respectively.While the OR (95％ CI) of objects with rs4684847 T allele were 1.42 ( 1.04-1.94),1.38 (1.03-1.92) and 1.37 ( 1.00-1.88),respectively.Conclusion The four SNPs including rs1800206 of PPARα,rs9794 of PPARδ and rs4684847,rs10865710 of PPARγ influenced high blood pressure,high SBP and high DBP to different degrees.

BACKGROUND:The study aimed to compare the therapeutic effect of recombinant tissue plasminogen activator (rt-PA) on the onset of acute cerebral infarction (ACI) at different time points of the first 6 hours.METHODS:A retrospective analysis was conducted in 74 patients who received rt-PA thrombolysis treatment within 4.5 hours after ACI and another 15 patients who received rt-PA thrombolysis treatment between 4.5-6 hours after ACI.RESULTS:National Institute of Health Stroke Scale (NIHSS) scores were statistically decreased in both groups (P>0.05) at 24 hours and 7 days after ACI. There was no significant difference in modified ranking scores and mortality at 90 days after the treatment between the two groups (P>0.05).CONCLUSIONS:The therapeutic effect and mortality of rt-PA treatment in patients with ACI between 4.5-6 hours after the onset of the disease were similar to those in patients who received rt-PA within 4.5 hours after the onset of this disease. Therefore, intravenous thrombolytic therapy for ACI within 4.5-6 hours after ACI was effective and safe.