Objective To evaluate the clinical diagnostic value of coronary artery calcification score(CACS)of multi-slice spiral computed tomography(MSCT)combined with carotid intima-media thickness(IMT)measure in elderly patients with coronary artery disease(CAD). Methods　CACS of MSCT,carotid IMT measure,and coronary angiography were performed in 68 patients,including 36 cases with CAD(CAD group)diagnosed by coronary angiography and 32 cases(control group)with coronary arterial stenosis(＜50% stenosis).CACS and carotid IMT were compared between two groups. Results　The coronary artery calcification score was significantly increased in CAD group compared with the control group[(349.5±86.3)vs.(74.7±25.2),t=13.670,P＜0.01],and it was increased with the severity of coronary arterial stenosis.The carotid intima-media thickness in CAD group showed significant difference with that in control group[(1.11±0.05)mm vs(0.69±0.13)mm,t=13.587,P＜0.01].In CAD group,CACS exhibited a significant positive correlation with carotid IMT(r=0.950,P＜0.01).The positive rates of CACS and carotid IMT were both 77.8% (28 cases)in CAD group and both 12.5%(4 cases)in control group,which showed significant difference between two groups(X2=28.976,P＜0.01). Conclusions　CACS of MSCT combined with carotid IMT have high sensitivity and specificity in evaluating coronary arteriaI stenosis.It can be used as a non-invasive examination to diagnose CAD in the elderly.

Objective To establish a novel chronic compressive cervical spinal cord injury rat model,to validate the chronic pathological characteristic.Methods Fifty-four SD rats were randomly divided into 3 groups,including control group(n =6),acute compressive group(4 h,24 h,respectively.n =6),and chronic compressive group(4 h,12 h,24 h,48 h,72 h and 1week,respectively.n =6).Two sizes of water-absorbing polyurethane polymer sheets were implanted into C5～6 epidural space on postero-lateral side in acute and chronic compressive group respectively,to induce a consistent compression in the cord after expanded.While a laminectomy on C5～6 was performed only in control group.The neurological integrity,MRI signal change in the cords,large motoneuron number in the ventral horn,and myelin staining intensity on posterior funiculus were studied.Results In the acute group at 4-24 h,the compression was confirmed significantly on T2WI image,as well as hypointense signal change intramedullary.These changes were consisted with intramedullary bleeding,tissue necrosis.Large motoneuron number(P ＜ 0.05),rather than myelin staining intensity (P ＞ 0.05),was significantly decreased compared with the control group and chronic compressive group.BBB score was 6.0 at 24 h.In the chronic group:cord distortion with progressive compression was observed on T2WI image,but without intramedullary bleeding signal change.At 4-12 h,intramedullary edema,central canal distortion were seen in the cords.Large motoneuron number and myelin staining intensity decrement were not significant(P ＞0.05).BBB score was 20.6.At 24-72 h,central canal enlargement,venous congestion,and edema were observed.Large motoneuron number was less than that in the control group.In the compressive epicenter,nerve fiber disorganization or rupture was observed.Myelin staining intensity decreased significantly after 48 h and 72 h compression (P ＜0.05).BBB score was 19.3.At lweek,vacuolation changes were noted and large motoneuron decreased (P ＜ O.05),as well as myelin density and staining intensity (P ＜ 0.05),suggesting nerve fiber demyelination.BBB score was 17.5.In the control group,there was no neurological deficit and pathological change in the cords.Conclusion The pathology and MRI characteristic consistent with chronic compressive injury change,which proved this method is able to induce a chronic course on the rat model,and established a reliable model foundation for cervical myelopathy.

BACKGROUND:Arthroscopic treatment of tibial eminence fracture requires tiny wire,induces less epiphyseal plate damage during operations,obtains strong fixations,alows early movement postoperatively,obviously attenuate the injuries,facilitate wound healing,and reduce complications.OBJECTIVE:To investigate the biocompatibility of arthroscopic reduction and wire fixation in treatment of fresh and old tibial eminence fractures.METHODS:Twenty-five patients with fresh and old tibial eminence fractures were treated with arthroscopic reduction and wire fixation from January 2010 to April 2012 in the Second People's Hospital of Yichang City.The postoperative fracture healing time and knee function improvement in the two groups were observed.RESULTS AND CONCLUSION: Compared with the fresh fracture patients,the fracture healing time was longer,Lachman test positive rate was higher in the old fracture patients than (P＜0.05),knee flexion and extension activity and Lysholm score were lower (P＜0.05).Experimental findings indicate that,arthroscopic reduction and wire fixation is a feasible clinical treatment of fresh and old tibial intercondylar eminence fractures.

The relationship between 3 polymorphisms sites [interleulin-4 (IL-4), IL-4 receptor (IL-4R) alpha chain and activation-induced cytidine deaminase (AICDA)] and adult allergic asthma in China was studied. By using case-control method, DNA and clinical data were obtained from allergic asthmatic patients and compared with those in the control subjects. The subjects were genotyped for the IL-4 C-589T promoter polymorphism, the IL-4R alpha chain Q576R and the AICDA C8408T by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The results showed that the IL-4 C-589T was not associated with adult allergic asthma in China. However, the IL-4R alpha chain 576R/R and AICDA 8408T/T frequency was significantly increased in allergic asthma group as compared with that in the control group [odd ratio (OR) = 3.797 and 9.127, respectively; P < 0.01)] and was correlated with the increased plasma total IgE. These data suggested that the IL-4R alpha chain 576R/R and AICDA 8408T/T genotypes confer genetic susceptibility to adult allergic asthma in China.
Alleles ; Asthma/etiology ; Asthma/*genetics ; Cytidine Deaminase/*genetics ; Immunoglobulin E/blood ; Interleukin-4/*genetics ; Phenotype ; *Polymorphism, Restriction Fragment Length ; RNA Processing, Post-Transcriptional ; Receptors, Interleukin-4/*genetics

Adult ; Aged ; Female ; Humans ; Intervertebral Disc Displacement ; diagnosis ; surgery ; Lumbar Vertebrae ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Thoracic Vertebrae ; surgery ; Treatment Outcome

Objective To evaluate the surgical techniques and clinical efficacy of retroperitoneoscopic ligation of renal lymphatic vessels outside adipose capsule and inside adipose capsule for comparison in the treatment of chyluria.Methods Retrospective anal-ysis of the retroperitoneal laparoscopic adipose capsule of kidney pedicle lymphatic duct ligation(group Ⅰ)and adipose capsule pathways in the kidney totally or subtotally free renal pedicle lymphatic ligation(group Ⅱ)and 1 1 1 patients with chyluria clinical data,compared two groups of operation time,bleeding volume,the rate of analgesia,postoperative gastrointestinal function recovery time,drainage time,postoperative recovery time,postoperative hospital stay and postoperative complications and other index differ-ence.Results Retroperitoneal laparoscopic operation group of adipose capsule in operation time,bleeding volume,postoperative an-algesia,postoperative gastrointestinal function recovery time,drainage time,postoperative recovery time,postoperative hospital stay and postoperative complications were better than the adipose capsule of kidney totally or subtotally free operation group,the differ-ence was statistically significant(P<0.05).Conclusion Retroperitoneal laparoscopic renal adipose capsule of kidney pedicle lym-phatic disconnection for the treatment of chyluria effect,and adipose capsule operation ways,the method less trauma,quicker recov-ery,can completely replace the renal adipose capsule total or Sub-total of free kidney pedicle lymphatic disconnection operation,wor-thy of clinical application.

Objective To assess the value of acoustic radiation force impulse (ARFI) imaging in the pathological damage of Henoch-Schonlein purpura nephritis on children by comparison with renal biopsy.Methods 50 cases of healthy control group as group A; 58 children with HSPN were divided into three groups according to pathological grading:Ⅰ ～ Ⅱ class (group B),Ⅲ class (group C) and Ⅳ ～ Ⅵ class (group D).ARFI was then used to measure the shear wave velocities(SWV) of renal cortex of each group,compared the differences SWV of each group.Results SWV values of children's renal cortex with HSPN were significantly higher (t =5.883,P =0.017) than those in the group A.Pairwise comparisons found that there were statistically significant differences between group D and the other three groups (P ＜0.05).According the ROC curve,the cut-off value of SWV was 2.59 m/s when the maximum area under the curve equal to 0.719,the sensitivity and specificity were 63％ and 67％.Conclusions ARFI technology can quantify the elastic properties of the kidney,which is expected as an important indicator to evaluate the pathological extent of damage of the HSPN.

Objective To investigate the clinical significance of preoperative colonoscopy for patients with benign anal diseases,and to compare the success rates of examination done by sedated colonoscopy and conventional colonoscopy.Methods The clinical data of 333 patients with benign anal disease who received preoperative colonoscopy at the Six Affiliated Hospital of Sun Yat-Sen University from April 2010 to March 2011 were retrospectively analyzed.All the patients were divided into the lesion group (120 patients) and normal group (213 patients)according to the results of colonoscopy.The measurement data and count data were analyzed using the t test and chi-square test,respectively.Results The age of patients in the lesion group was (48 ± 14) years,which was significantly older than (42 ± 14) years (t =3.75,P ＜ 0.05).The constituent ratio of patients older than 40 years in the lesion group was 72.50％ (87/120),which was significantly higher than 39.44％ (84/213) in the normal group (x2=33.59,P ＜0.05).The proportions of male and female patients were 71.67％ (86/120) and 28.33％ (34/120) in the lesion group,and 62.44％ (133/213) and 37.56％ (80/213) in the normal group,with no significant difference between the 2 groups (x2 =2.90,P ＞ 0.05).The benign anal diseases in the lesion group included polyp (80 cases),enteritis (30 cases),malignant tumor (7 cases),infflammatory bowel disease (7 cases),diverticulum (5 cases) and ulcer (1 case).The application rates of sedated colonoscopy in the lesion group and the normal goup were 51.67％ (62/120) and 54.93％ (117/213),respectively,with no significant difference between the 2 groups (x2=0.33,P ＞0.05).The success rate of terminal ileum intubation was 99.44％ (178/179) in patients who received sedated colonoscopy,which was significantly higher than 95.45％ (147/154) of patients who received conventional colonoscopy (x2 =5.61,P ＜ 0.05).Conclusion Patients with benign anal disease might complicated with colorectal lesions,and sedated colonoscopy is recommended for preoperative diagnosis,especially for patients who are older than 40 years.

Objective To explore the function of colonic mucosal barrier of patients with colonic slow transit constipation (STC).Methods From June 2008 to June 2012,a total of 136 patients with STC were enrolled.Among them,course of disease of 55 cases was between one and six years,of 43 cases was between six and 10 years,and of 38 cases was over 10 years.The colonic transit time of 66 cases was between three and five days,of 42 cases was between five and seven days,and of 28 cases was over seven days.Altogether,35 cases received subtotal resection of the colon.At same time,individuals who received partial resection of the colon because of single polypus were set as control group.Fasting blood and urine samples of all subjects were collected.The colonic specimens of STC patients who received surgery and control group were harvested.The urinary lactulose and mannitol ratio (L/M) was detected by high performance liquid chromatography (HPLC).The level of blood Dlactic acid (D-LAC) was tested by enzymatic spectrophotometric.The level of blood diamine oxidase (DAO) was determined by speetrophotometry.The level of endotoxin (ET) was detected by azo chromogenic substrate limulus test.The colonic epithelial cells membrane resistance (TER) and paracellular mannitol permeability (PMP) were measured with Ussing perfusion chamber.t-test was performed for comparison between groups.Results Urinary L/M of STC group and control group was 0.16±0.03 and 0.10±0.02,respectively.The level of blood D-LAC was (1.81±0.19) and (1.04±0.13) mmol/L.The level of blood DAO was (17.07±1.81) and (9.78±1.14) U/L.The level of blood ET was (64.20±6.85) and (51.30±5.90) EU/L.The TER of colonic epithelia cell was (61.23±7.76) and (75.87±9.65) Ω/cm2.The PMP of colonic epithelia cell was (3.17±0.35) ％ and (2.14 ±0.22)％.All the differences were statistically significant (t =3.185,3.378,3.863,3.201,3.125 and 3.543,all P＜0.05).Among patients with disease course between one and six years,six to 10 years and over 10 years,colonic transit time of STC between three and five days,five to seven days and over seven days,urinary L/M,blood D-LAC level and blood DAO level increased along with the disease course and colonic transit time and the differences were statistical significantly compared with control group (urinary L/M:t=1.993,2.311,2.356,2.204,2.347 and 3.673; blood D-LAC level:t=2.023,2.886,4.124,1.999,2.998 and 3.465; blood DAO level:t=1.994,2.995,4.423,2.203,3.673 and 5.211; all P＜0.05).Compared with control group,there were significant differences in blood ET level of course of STC between six and 10 years,over 10 years,colonic transit time of STC between five and seven days and over seven days (t=2.121,4.245,3.241 and 4.657,all P＜0.05).Conclusion The permeability of colonic mucosal barrier increased and which was more significant in longer colonic transit time and long course of disease.

Objective:To investigate the cause, treatment, and prognosis of delayed hemorrhage in patients who underwent radical gastrectomy. Methods:The clinical data of 294 patients who underwent radical gastrectomy in the Second Hospital Affiliated from Nanchang University from January 2015 to October 2015 were retrospectively analyzed. Results:A total of 15 patients suffered from delayed hemorrhage and accounted for 5.1%of the gastric cancer cases in our hospital for the same period of radical gastrectomy. Of the 15 patients, 9 underwent laparoscopic radical gastrectomy and 6 received open radical gastrectomy resection. Large vascular hemorrhage was found in 7 cases. Anastomosis and anastomotic ulcer induced hemorrhage were observed in 3 cases. Duodenal stump rupture induced hemorrhage was detected in 2 cases. Hemorrhage was also observed in some parts in 2 cases. Likewise, hemorrhage occurred in 1 case, but the affected parts were unknown. Of the 11 patients who underwent a second operation, 2 were subjected to digital subtraction angiography (DSA) and transcathete arterial embolization (TAE) to stop hemorrhage. Endoscopic hemostasis was performed to stop hemorrhage in 1 case. Conservative treatment was administered to stop hemorrhage in 1 case. The secondary surgery rate was 73.3%(11/15) with mortality and curative rates of 40%(6/15) and 60%(9/15), respectively. Conclusion:For delayed hemorrhage after D2 of gastric cancer, a second radical surgery and death rates were high. Therefore, patients suffering from hemorrhage should be subjected to comprehensive clinical treatment and positive measures. Major vascular bleeding, anastomotic leakage, anastomotic ulcer, and duodenal stump rupture are relevant risk factors. Anastomotic fistula and celiac artery bleeding complications caused hemorrhage is the leading cause of death. Extensive bleeding and unstable vital signs should be checked. A second operation and abdominal drainage should also be timely conducted to as effective methods. Realistic and conservative treatment can be administered to patients with stable vital signs and low amount of blood loss. Endoscopic hemostasis can be applied to alleviate simple anastomotic ulcer bleeding. DSA can be initially performed to detect unknown bleeding sites. TAE can be subsequently used to treat hemorrhage.