Objective To investigate the risk factors for carotid artery atherosclerosis in young and middle-aged patients with ischemic stroke and the effect of serum lipoprotcin(a) [(Lp (a)] level on young and middle-aged patients with ischemic stroke.Methods Patients with ischemic stroke between the ages of 18 to 55 were enrolled.Carotid artery ultrasonography was used to evaluate the degree of carotid artery atherosclerosis,and the concentrations of serum total cholesterol,triglycerides,high density lipoprotein cholesterol,low density lipoprotein cholesterol,very low density lipoprotein cholesterol,apolipoprotein A1,apolipoprotein B and Lp(a) were detected.According to the results of carotid ultrasound,the patients were divided into groups of without atherosclerosis,plaque without stenosis,and carotid artery stenosis.The demographic and clinical features were compared among the 3 groups.Multivariate logistic regression analysis was used to identify the independent risk factors for carotid artery atherosclerosis in young and middle-aged patients with ischemic stroke.Results A total of 106 patients with ischemic stroke (n =50 in the without atherosclerosis group,n =44 in the plaque without stenosis group,n =12 in the carotid artery stenosis group) were enrolled in the study.The constituent ratios of age (45.98 ±7.12,50.07 ±4.79,and 50.92 ± 1.83 years,respectively; F =7.169,P =0.001),hypertension (26.0％,47.7％ and 58.3％,respectively; x2 =6.862,P =0.032),diabetes mellitus (22.0％,45.5％ and 66.7％,respectively; x2 =10.729,P =0.005),hyperlipidemia (24.0％,40.1％ and 75.0％,respectively; x2=11.372,P=0.003) and smoking (34.0％,61.4％ and 75.0％,respectively;x2 =10.93,P=0.006),as well as the serum high-density lipoprotein cholesterol (1.03 ± 0.26,0.95 ± 0.26 and 0.76 ± 0.08 mmol/L,respectively; F=5.882,P =0.004) and Lp (a) (0.108 ± 0.044,0.155 ± 0.028 and 0.200 ± 0.011 g/L,respectively; F =41.556,P =0.000) levels had significant differences in the 3 groups.Multivariate logistic regression analysis showed that age ＞ 48 years (plaques without stenosis:odds ratio [OR] 2.89,95％ confidenee interval [CI] 1.20-6.96,P =0.018; carotid artery stenosis:OR 4.43,95％ CI 1.19-16.57,P =0.027),hypertension (plaque without stenosis:OR 2.60,95 ％ CI 1.09-6.18,P =0.031; carotid artery stenosis:OR 3.99,95％ CI 1.08-14.77,P =0.039),diabetes (plaque without stenosis:OR 2.96,95％ CI 1.21-7.23,P=0.018; carotid artery stenosis:OR 7.09,95％ CI 1.79-28.02,P =0.005),hyperlipidemia (plaque without stenosis:OR 2.19,95％ CI 0.91-5.31,P =0.082; carotid artery stenosis:OR 9.50,95％ CI 2.21-40.86,P =0.002),smoking (plaque without stenosis:OR 3.08,95％ CI 1.33-7.16,P =0.009; carotid artery stenosis:OR 5.82,95％ CI 1.39-24.38,P =0.016),and Lp (a) (plaque without stenosis:OR 4.38,95％ CI 1.76-10.90,P=0.001; carotid artery stenosis:OR 12.80,95％ CI 2.73-52.67,P =0.001) were the independent risk factors for carotid artery atherosclerosis in young and middle-aged patients with ischemic stroke.Conclusions Age,smoking hypertension,diabetes and Lp(a) were the independent risk factors for carotid artery atherosclerosis in young and middle-aged patients with ischemic stroke.

Advanced-stage Hodgkin's lymphoma (HL) has become a curable disease in the majority of patients.ABVD is considered to be the standard therapy,but debates continue regarding the role of radiation therapy(RT)in this patient population. The incorporation of interim positron emission tomography (PET) imaging, and characterization of HL on cellular and molecular levels are emerging as tools for treatment stratification and predictors of disease status. Therapeutic advances over the past 3 decades have resulted in the cure of the majority of the patients with advanced-stage HL.Several questions have emerged when considering what constitutes optimal therapy with a balance between a high cure rate and minimizing shortand long-term toxicity.This review focuses on 3 key elements:what is the optimal chemotherapy? What is the role of radiation therapy(RT)in advanced HL? Can therapy based on clinical biological risk factors be adapted?

Antiretroviral therapy(ART)has been started in an increasingly earlier period in clinical practice.However,owing to the failure of immunological reconstitution or maintenance of latent HIV-1 reservoir in present antiviral treatment,interleukin-2(IL-2)is widely used as an adjuvant to ART with a view to intensifying immunological reconstitution and to activating latent HIV-1 infections.Some conclusions could be drawn as follows,1)IL-2 can extend the half-life of CD+4 T cells and increase the number of CD+4 T cells.2)Compared with ART alone,IL-2 and HAART combination can not reduce HIV-1 related opportunistic infection or death.IL-2 clinical usage is mainly focused on purging HIV-1 reservoir.3)IL-2 combined with ART could increase out flow rate of HIV-1 latent reservoir to reduce HIV-1 infected quiescent memory cells in peripheral circulation even to an undetectable level.4)IL-2 is supposed to be used periodically and for a long period of time.

〔Abstract〕 Taking Wuxi People′s Hospital Affiliated to Nanjing Medical University as an example, the paper introduces the constitu-tion, software architecture and main functions of Clinical Decision Support System ( CDSS) .The system is integrated with Electronic Medical Records ( EMR) system, providing scientific and acurate information support for clinicians in the whole diagnosis process.It has positive significance to improve the work quality and reduce medical errors.

Chromosome Aberrations ; radiation effects ; DNA Damage ; radiation effects ; Electromagnetic Fields ; adverse effects ; Sister Chromatid Exchange ; radiation effects

Humans ; Hyperostosis, Cortical, Congenital ; diagnosis ; Infant ; Male

Objective Toexplore the findings of bile flow artifacts (BFA)on MR cholangiopancreatography(MRCP). MethodsEighty five patients with normal common bile duct (CBD)and 95 patients with dilated CBD who had MRCP examination were studied retrospectively. Findings of BFA on original thin images of MRCP were recorded. Date were tested by Chi-square test and Spearman ceefficient of rank correlation analysis. ResultsThe rate of BFA in CBD with normal group was 38. 8％ ( 33/85 ), in dilated group was 83.2％ (79/95), there was statistically significant difference between them( x2 ＝ 37. 512,P ＝ 0. 000). BFA was not observed when the diameter of CBD was no more than 4 mm. BFA was partly observed when the diameter of CBD was 4 mm ＜ ψ≤ 8 mm, single- string sign was predominant findings (52.6％ ,30/57 ). Three-string sign was predominant findings in CBD with slight-dilated group ( 85.7％,36/42). Multi-string sign was predominant findings in CBD with medium-dilated group (84. 6％, 22/26 ).There was statistically significant difference between each groups ( x2 ＝ 284. 561, P ＝ 0. 000 ).BFA had different manifestations with CBD of different diameter, there was relative between them ( r ＝ 0. 553, P ＝0. 000). ConclusionBFA can occur in CBD with normal diameter. CBD with dilated group has higher rate of BFA than CBD with normal diameter. Manifestations of BFA are relative with the diameter of CBD.

Objective To investigate the imaging characteristics of autoimmune pancreatitis (AIP)and its diagnostic value.Methods Imaging examinations and clinical data of 13 patients with AIP were reviewed retrospectively.Results All patients had enlargement of pancreas either diffusely ( n =11 ) or focally in pancreatic head ( n =2 ).The swollen pancreas was of homogeneous density on CT scan ( n =13 ),hypointense on T1-weighted images and mildly hyperintense on T2-weighted images in 4 patients.It was demonstrated as mild enhancement on artery phase of dynamic imaging and progressive enhancement on portal and delayed phase images.Capsule-like enhanced rim was presented around the pancreas in 9 patients.Stricture or obliteration of the common bile duct located in pancreatic head was found in 10 patients accompanied by intrahepatic bile duct dilation.Pancreatic duct was invisible on axial images in 11 cases.Among the 6 patients underwent MRCP,it was showed diffuse and irregular narrowing of the main pancreatic duct and stricture of common bile duct located in pancreatic head in 4 cases.ERCP showed diffuse and irregular narrowing of the main pancreatic duct in 7 cases.Extra-pancreatic lesion included veins around pancreas involvement in 8 cases;multiple low density renal lesions in 6 cases; retroperitoneal fibrosis in 2 cases; stricture of hilar duct,interstitial lung disease and ankylosing spondylitis in 1 case,respectively.Conclusions AIP shows some characteristic imaging features,and imaging examinations play an important role in the diagnosis of AIP.Recognition of extra-pancreatic lesions aids in the correct diagnosis of AIP.

Objective To evaluate the hematologic effects of linezolid in advanced aged patients with hospital onset of infection.Methods The clinical characteristics and complete blood routine examination results of 45 elderly patients aged(92.9±5.2)years treated with linezolid over 600 mg of lowest dose everyday for more than 72 hours were retrospectively analyzed.Results Among the 45patients,20 patients(44.4％)had substantially lower platelet,6 patients(13.3％)lower haemoglobin,1 patient(2.2％)lower absolute neutrophil,and the linezolid treatment in 19 patients were discontinued due to hematological system adverse reactions.The significant drop in platelet occurred at(10.2±3.3)days after treatment.The significant drop in hemoglobin occurred at(9.8±3.0)d after treatment.The lowest count of platelet and hemoglobin took place at(13.1±3.9)d and (10.5±3.5)d after treatment,respectively.The drops in platelet and hemoglobin of some patients took place after cease of treatment.Stepwise logistic regression analysis revealed that treatment duration(OR =1.407,P＜0.05)and creatinine clearance rate(OR=0.732,P＜0.05)were the risk factors for thrombocytopenia.Conclusions The elderly patients using linezolid more likely suffer from adverse reactions of hematological system,particularly thrombocytopeniawhich is significantly more common in patients with renal insufficiency and prolongation of treatment time.The blood routine examination should be monitored closely when elderly patients are treated with linezolid.

Objective To analyze the factors affecting prognosis of children with non-Hodgkin′s lymphomas(NHL).Methods Thirty patients of childhood NHL histologically proven in Shanghai children′s medical center from Jan.1996 to Dec.2000 were analyzed.The patients were divided into groups according to some clinical factors that may have predictive significance including age,gender,immunologic phenotype,general system symptom,the size of tumor bulk,bone marrow involvement,mediastinal involvement,hepatomegaly or liver involvement,splenomegaly or spleen involvement and early response to chemotherapy,then the difference of survival rate were compared between groups.Survival analysis was performed by the Kaplan-Meier method,and difference between groups were campared using the Log-rank test.Results The 3-year survival rate was better in patients without giant tumor bulk than that with giant tumor bulk(P0.05).Conclusions Bone marrow involvement and the size of tumor bulk have very significant influence on prognosis of childhood NHL,and splenomegaly or spleen involvement have significant influence on disease-free survival.It can′t be proven in childhood NHL in this study.