Objective To evaluate Meta-analysis in assessing the overall diagnostic value of adenosine stress echocardiography (ASE) in patients with coronary heart disease (CHD). Methods Relevant English and Chinese articles about ASE for assessing diagnostic accuracy of CHD were collected from the literatures published from 1994 to 2007 in China and abroad. Meta-analysis was conducted with the method recommended by the Cochrane Collaboration. Results Twelve papers were included. The reported sensitivity of ASE for the diagnosis of CHD ranged from 0.69 to 0.94, and the specificity ranged from 0.71 to 1.00. The pooled weighted sensitivity and specificity was 0.81 (95%CI 0.77-0.85) and 0.83 (95%CI 0.78-0.87), respectively;and the pooled positive and negative likelihood ratio was 4.81 (95%CI 3.65-6.33) and 0.22 (95%CI 0.18-0.28), respectively. The area under the curve of the summary receiver operating characteristic was 0.8968±0.0151. Conclusion ASE is medium to highly accurate in the diagnosis of CHD.

Objective To study the cause, prophyl ax is and management of the complications of laser treatment for varicose veins of the lower extremity. Method From Sep 2003 to Dec 2004, 52 patients (65 limbs) underwent endovenous ablat ion procedures. The laser was introduced into the vein to achieve venous occlusi on. Results Postoperative complications included ecchymosis in 12 cases, skin burn in 14 cases, saphenous nerve injury in 7 cases, thrombophlebitis in 3 cases, and subcutaneous fat liqu idation and infection in 2 cases. Most of the complications subsided after sympt omatic treatment in 2 to 3 weeks. Conclusion Most complications of laser treatment for varicose veins are transient and self-healing.

Objective To evaluate the value of vascular intervention in the diagnosis and management of hemobilia. Methods With Seldinger's technique ,digital subtraction angiography of superior mesenteric artery and hepatic arteriography were performed on 3 patients with hemobilia, two of whom manifested hemobilia after the operation of liver trauma and one of whom did after the operation of command bile duct stones . Arteriography showed the bleeding vascular branch, the false aneurysm and the arteriovenous fistula. And then a small catheter was put into the bleeding focus. The bleeding branch arteries were selectively embolized with embolus of n-butyl cyanoacrylate (NBCA),PVA granule,spring wire loop and gelatin sponge. Results Two cases showed diffuse bleeding focus and another showed a local bleeding focus. Two cases had expression of false aneurysm and one showed expression of ateriovenous fistula. The artery branches of the bleeding focus were successfully embolizated and the hemobilia stopped immediately. Conclusions Vascular intervention is an effective method for the diagnosis and management of hemobilia.

0.05).(2)In 67 cases with pre-and post-image selection and reconstruction in single-slice or twin-slice helical CT,the slice concordance rate in measurement was 20.98% and 97.01%,respectively(?2=80.22,P=0.00).The slice concordance was all accomplished with the same method in multi-slice helical CT in 5 cases.(3)Peak heights and SPN-to-aorta ratios of malignant [(38.48?14.32)HU,(19.64?9.52)% ] and inflammatory SPN [(42.48?11.55)HU,(21.14?7.77)%] were significantly higher than that of benign SPN [(9.52?3.78)HU,(3.41?1.86)%,P0.05).Slice optimization of dynamic contrast-enhanced CT scan improved the diagnostic accuracy of SPN from 78% to 80%.Conclusion No significant efficacy was found in the attenuation between primitive images and reconstructive images with the same slice thickness of homogenous material.Slice concordance of dynamic contrast enhanced spiral CT could reflect objectively the morphological appearance and CT value changes of solitary pulmonary nodules,and may improve the veracity of diagnosis.

Objective To study the efficacy of minimally invasive treatment for lower extremities venous ulcers.Methods A total of 48 patients with lower extremities venous ulcers(56 hmbs)wereexamined with venography to identify the primary lesion that resulted ulcer. According to the type and degree of hemedynamie abnormality,high ligation of the great saphenous vein combined with endovenous laser treatment,subfascial endoscopic perforator surgery,and external banding valvuloplasty of the superficial femoral vein were done in 8 eases(8 limbs),high ligafion of the great saphenous vein combined with endovenous laser treatment and subfascial endoscopic perforator surgery were carried out in 24 cases(28 limbs),and high figation of the great saphenous vein combined with endovenous laser treatment was performed on 16 cases(20 linbs).In all cases,the ulcers were eircumferentially ligated at the same time.Results After the operations,superficial varicosis,pigmentations,and eczematous relieved remarkably in the 56 limbs.In 51 limbs,heavy feeling,ache,and edema disappeared 14-18 days after operation.The ulcers of the 56 limbs healed l6-48 days after operation.During 4 to 46 months follow up,ulcers recurred in 4 limbs(7.1%).Conclusions It is effective to correct the incompetence of the superficial,perforating,and deep veins and manage the surface of ulcers for lower extremities venous ulcers.Endovenous Iaser treatment and subfascial endoscopic perforator surgery are easily performing,minimally invasive,and safe operations.The recurrence of leg ulcers can be reduced by external banding valvuloplasty of the superficial femoral vein.

Objective To study a new stuff-block therapy method to promote closure of external gastrointestinal fistula. Methods Twenty-eight patients with different type of external gastrointestinal fistulae in different sites were treated with fibrin glue stuff-blocking technique. The fibrin glue dispensary system designed by the authors has a double-lumen catheter in different size.When the catheter inserted via the fistula to about 1cm from the intestinal fistula,the glue was relased through the catheter to seal the whole fistula. Results The insertion of dispensary catheter into the fistulae was successful in all the cases. No side-effect was observed in all the patients. In 17 patients the fistulae healed about one week after one time treatment, 11 patients′ fistulae healed in about two weeks after 2-3 time treatment. Twenty-five patents were followed up for 3-6 months . The fistula sustained healing and normal deal was restored.Conclusions Stuff-blocking of the fistula with fibrin glue by means of the dispensary system designed by the authors has satisfy results. It provided a new method for the treatment of external gastrointestinal fistula .

Adult ; Case-Control Studies ; Humans ; Interleukin-12 ; blood ; Liver Diseases, Alcoholic ; blood ; Male ; Middle Aged ; Transforming Growth Factor beta1 ; blood

Objective This epidemiologic survey aims to investigate the changes in prevalence and risk factors for non-alcoholic fatty liver disease (NAFLD)in the elderly people who are living within Pudong San-lin region.Methods We retrospectively analyzed annual physical check-up data in 2012 and 2014 for elderly people living in this region (aged≥70years).Demographic variables including age,sex,blood pressure,body mass index (BMI)were recorded.Serum fasting glucose level was determined and liver and kidney function were assessed.Abdominal echo-Doppler examination was performed.NAFLD was diagnosed according to Chinese guideline on management of NAFLD (revised version).Results Among 2127 sub-jects with physical check-up in 2012,the occurrence rate of NAFLD was 27.46% (23.02% and 31.02%for men and women,respectively).Type 2 diabetes was detected in 224 subjects and 33.93% of them de-veloped NAFLD (26.73% and 39.84% for males and females,respectively).Among 1771 subjects who received physical check-up in 2014,the occurrence rate of NAFLD increased up to 32.29%,with NAFLD rate being 29.97% and 34.19% for men and women,respectively.In 185 subjects with type 2 diabetes, 49.19% developed NAFLD (47.56% and 50.49% for men and women,respectively).Thus,compared with the findings during physical check-up in 2012,the occurrence rate of NAFLD was significantly in-creased during physical check-up in 2014 for both male and female subjects of overall and diabetic popula-tions (P <0.05 for all comparisons).Further analysis showed that for 185 diabetic patients who had phys-ical check-up in 2014,systolic and diastolic blood pressures,BMI,and serum levels of fasting glucose lev-el,alanine aminotransferase,aspartate aminotransferase,total cholesterol,and triglyceride were significant-ly higher in patients with NAFLD than in those without NAFLD (all P <0.05).Multivariate regression a-nalysis revealed that BMI,total cholesterol and triglyceride levels were independent risk factors for occur-rence of NAFLD in diabetic patients.Conclusions This epidemiologic survey demonstrates a significant increase in the occurrence rate of NAFLD for the elderly people (especially with type 2 diabetes).Hyper-lipidemia,obesity,and hypertension are major risk factors for NAFLD in diabetic patients.

Objective To establish gastric bypass surgery model with SD rat and analyze the influence factors and preventive measures so as to accumulate experience and skills for further developing gastric bypass surgery model on diabetic rat( GK rat) . Methods Gastric by-pass surgery was operated on 30 SD rats. Summarized modeling experience and analyzed various factors affecting modeling success. Results 17 rats weresuccessfully survived after surgery and 13 failed, with the mortality rate 43. 3%. Three rats died during operation, including two for anesthesia and one for heart failure;one died due to anastomotic bleeding two hours after surgery. Eight died in the third day after surgery, including two for infection, two for intestinal necrosis, four for anastomotic stenosis or obstruction. One died because of anastomotic leakage caused by mistaking and satiety the fifth day after surgery. There were no other complications such as wound dehiscence occurred in this group . Conclusion Establishing models of gastric bypass surgery with SD rats which is regarded as pre-experiment of building models of gas-tric bypass surgery with GK rats is economical and feasible. Anesthesia and perioperative management, surgical techniques and infection pre-vention and control are the main factors affecting modeling. The survival rate of rat model could be increased if related factors well controlled.

Objective To explore impact of BMI on the clinical efficacy of treatment of type 2 diabetes mellitus after the laparoscopic gastric bypass. Methods Twenty patients were randomly selected from type 2 diabetes mellitus patients with BMI of 25 ~28 kg/m2 after laparoscopic gastric bypass surgery in our hospital from 2010 to 2013,20 patients from type 2 diabetes mellitus patients with BMI of 28~35 kg/m2 and 20 patients from type 2 diabetes mellitus patients with BMI≥35 kg/m2 . Accordingly,the total of 60 patients were divided into low BMI group,middle BMI group and high BMI group. The difference of the rate of blood glucose control and other indicators between three groups were compared and analyzed. Results The rate of blood glucose control in low BMI group was 75%,middle BMI group was 85%, and high BMI group was 90%. There was no statistical difference of the rate of blood glucose control between three groups at 12 months after laparoscopic gastric bypass surgery. The blood glucose and weight obviously improved in all patients,and fasting insulin and postprandial ser-um insulin decreased at 12 months after laparoscopic gastric bypass surgery. Conclusion All the patient of type 2 diabetes mellitus with dif-ferent BMI in three group can acquire satisfying clinical therapeutic effect after the laparoscopic gastric bypass.