Objective To observe the efficacy and safety of trimetazidine/coenzyme Q10 combination in the treatment of the elderly patients with chronic heart failure(CHF).Methods Sixty-two male patients aged over 80 years with CHF were randomly divided into intervention group and control group.Patients in control group received optimal conventional CHF therapy according to the guideline for CHF,while patients in intervention group received trimetazidine of 20 mg,3 times per day,coenzyme Q10 20 mg,3 times per day,additionally for 6 weeks.Left ventricular ejection fraction (LVEF),left ventricular end diastolic diameter (LVEDD),plasma brain natriuretic peptide (BNP),6 min walking distance (6MWT) and NYHA cardiac function classification of two groups before and after treatment were observed.Results Before treatmen,the NYHA function class of patients in intervention and control groups were 2.8±0.7,2.7±0.7 respectively,after treatment were 2.1± 0.6,2.4 ± 0.7 respectively,the differences were significant before and after treatment (t=6.808,2.249;P＜0.01,P＜0.05).Before treatment,BNP of intervention and control groups were (540±351)ng/L,(483 ± 351) ng/L respectively,after treatment were (219± 172) ng/L,(316 ± 202) ng/L respectively,the differences were significant before and after treatment (Z =-4.927,-4.042;P ＜ 0.01).Moreover,after treatment,NYHA function class and plasma BNP in intervention group were significantly better than those in control group (t =-2.109,P ＜ 0.05;Z =-2.219,P ＜ 0.05).Before treatment,LVEF,LVEDD and 6MWT of intervention group were (44.3 ± 3.1) ％,(54.0 ± 4.7) mm and (217.0 ± 60.9) m respectively,after treatment were (46.8±3.9) ％,(53.2±4.3) mm and (267.0±91.1) m respectively,the differences were significant before and after treatment(t=-8.313,2.254,-4.561;P＜0.01 or P＜0.05).Moreover,after treatment,LVEF and 6MWT in intervention group were significantly better than those in control group ((44.9± 3.5)％,(213.2 ±78.1) m;t =2.000,2.186;P ＜ 0.05).No significant adverse events were detected in the intervention group.Conclusion Combination of trimetazidine and coenzyme Q10 on the basis of the conventional treatment in the elderly with CHF,can further improve cardiac dysfunction and have a good safety.

Objective To investigate the prevalence of hyperuricemia in health check-up population of Beijing suburb.Methods Total 1 336 rural residents in Nankou Township of Beijing received health check-up from July to Aug 2014,including 686 subjects aged 20-59 years (young/middle-aged group) and 650 subjects aged 60-96 years (elderly group).The blood pressure and body mass index (BMI) were measured;serum uric acid (SUA),fasting blood glucose (FBG) and blood lipids (TG,TC,HDL-C,LDL-C) were determined.The SUA levels ＞ 420 μmol/L for male and ＞ 360 μmol/L for female were defined as hyperuricemia.Results The four quartiles of SUA levels were 27.00-254.59 μmol/L (Q1),254.60-302.35 μmol/L (Q2),302.36-359.78 μmol/L(Q3) and 359.79-702.0 μmol/L (Q4).The prevalence of hyperuricemia was significantly higher in young/middle-aged group than that in elderly group [20.41％ (140/686) vs.13.85％ (90/650),x2 =10.08,P =0.001 5],the systolic blood pressure [SBP,(126.8±15.7) vs.(116.7±12.0)mmHg(1 mmHg=0.133 kPa),t=2.76,P=0.008],FBG [(7.40±4.10) vs.(6.11 ±2.03)mmol/L,t=2.12,P=0.036],TC [(5.52±1.10) vs.(5.23±1.00)mmol/L,t =2.04,P =0.045],LDL-C [(3.5 ±0.7) vs.(2.4 ±0.9)mmol/L,t =2.21,P =0.029]in young/middle-aged group were significantly higher than those in elderly group.BMI,FBG were significantly higher in Q4 than those in other quartiles [BMI:(26.44 ± 3.88) vs.(24.19 ± 3.37),(25.49±3.42) and (25.61 ±3.49)kg/m2,t =2.78,P=0.008;FBG:(8.19 ±1.52) vs.(6.34±1.34),(6.09 ± 1.51) and (6.40 ± 1.98) mmol/L,t =2.80,P =0.007].The triglyceride (TG) levels in group Q3 and Q4 [(1.85 ± 0.90) and (1.92 ± 0.44) mmol/L] were higher than those in Q1 and Q2 [(1.37 ±0.76) and (1.70 ±0.84) mmol/L,t =2.1,P =0.035].Only 9.57％ subjects (22/230)with hyperuricemia was not combined with metabolic disorder;subjects combined with one and two metabolic disorders accounted for 20.87％ (48/230) and 69.57％ (160/230),respectively.Conclusion Screening for hyperuricemia is important for comprehensiye treatment and management of hyperuricemia in rural residents,especially in the young and middle-aged population.

Objective To investigate the clinical feactures of patients with numerous dilated Virchow-Robin space in basal gangalia.Methods Eight patients with cribriform state in striatum in brain MRI at Peking Union Medical College Hospital from March 2013 to October 2013 were enrolled.The clinical data including age,gender,common vascular risk factors and clinical manifestations were analyzed.Cognitive functions,balance and gait disturbance,as well as activity of daily living were assessed.Results All of the eight patients are male,aged from 69 to 80.All the patients had a history of hyperlipidemia,while 7 of them had hypertension.The primary complaint was either gradual motor function decline or memory impairments (3/8),or dizziness (1/8).The other 4 of them were diagnosed as stroke or transient ischemic attack.Among the 8 patients,four had mild deterioration in activity of daily living function (Barthel index 65-85).Cognitive impairment was common (8/8,the Montreal Cognitive Assessment scores 19-27),while word recall was the mostly affected cognitive domain (8/8).Gait and balance dysfunction were found in three patients (3/8,Tinetti scores ≤ 24).Conclusions Man is more likely to have predisposition to cribriform state in striatum.Mild cognitive impairments and gait abnormality are common clinical manifestations of the disease.

Objective To investigate current situation of prescription of traditional Chinese medicine (TCM) for acute stroke patients.Methods From June 2008 to October 2010,with simple cluster sampling,48 centers were randomly assigned to the intervention group receiving a standardized treatment strategy,and the usual care group without specific recommendations for treatment.No specific recommendations or restrictions of TCM were proposed for both groups.Consecutive hospitalized patients with acute ischemic stroke were recruited in this study.Clinical data and treatment strategy (including TCM) were recorded by trained investigators.The prescription of TCM three months prior to admission and at discharge was recorded and analyzed.The chi-square test was used for analysis of qualitative data.Results Totally 3 664 patients were included in the analysis (1 709 patients in standard care group and 1 955 patients in the usual care group) with male to female ratio 2∶ 1.The difference of distribution of age,sex and education level between the two groups was not statistically significant.One hundred and eighty-seven patients (5.10％) had taken TCM three months prior to admission,81.28％ of them only taking one type of TCM,without significant difference between the two groups.The percentage of patients taking TCM at discharge was significantly increased to 30.65％ for all the patients with higher percentage (38.16％) in the usual care group than that in the standard care group (22.06％).The percentage of using more than one type of TCM was also higher in the usual care group (x2 =141.43,P ＜ 0.01).Totally,112 types of TCM were prescribed at discharge.Conclusions Nearly one third of hospitalized patients with acute stroke were prescribed TCM at discharge,with mostly monotherapy and a great variety.

Objective Percheron artery is an uncommon anatomic variant. Percheron artery infarction with unilateral embryonic posterior cerebral artery ( PCA ) was rarely reported.The aim of this study was to characterize the clinical and imaging patterns of Percheron artery infarction with the unilateral embryonic PCA for early diagnosis and treatment.MethodsClinical and imaging data of 2 patients with Percheron artery infarction were reviewed retrospectively.ResultsTwo patients presented acute coma and one had paroxysmal blurred before coma.On neurological examinations,one patient had vertical gaze palsy besides two were unconsciousness. MRI showed symmetrical high signal intensity on diffusion weighed imaging (DWI)in bilateral paramedian thalami in two patients and a distinct pattern of V-shaped hyperintensity on DWI andFLAIR was present on the midbrain in one patient. Digital subtraction angiography and magnetic resonance angiography demonstrated unilateral embryonic PCA in two patients.ConclusionsThe classical clinical symptoms,symmetrical high signal in bilateral paramedian thalami and V-shaped sign in midbrain on DWI can improve recognition,evaluation and management of Percheron artery infarction.The unilateral embryonic PCA may be underlying risk factor of Percheron artery infarction.

Objective To examine the recurrent ischemic stroke(RIS)in hospitalized patients predicted by Essen Stroke Risk Score(ESRS)and investigate the effect of intensive antiplatelet therapy in patients with high risk of RIS. Methods Retrospective analysis of patients with acute noncardioembolic ischemic stroke consecutively admitted to Peking Union Medical College Hospital(PUMCH)during 2001-2008. All 1008 patients were included in this study, 377 hospitalized in 2001-2002, 315 in 2005 and 316 in 2008. High risk of RIS was defined as ESRS ≥3. The average ESRS score in three groups and percentage of patients with high risk of RIS in each group were calculated. Risk of RIS was evaluated by comparing the average ESRS score in these three groups. Patients with high risk and taking clopidogrel treatment were also evaluated. Results Average ESRS score was 2. 67 ± 1.47,3.55 ± 1.40 and 3.93 ± 1.48(F= 150. 85,P=0.000)in groups of patients hospitalized in 2001-2002, 2005 and 2008 respectively. A significant difference was shown in percentage of high risk patients with ESRS ≥3 in three groups: as 51.64% in 2001-2002,77. 19% in 2005 and 85. 45% in 2008(X2=98.30,P=0. 000),showing a trend of increasing risk of RIS. Except for patients age, rates of having the risk factors in patients increased significantly, including hypertension, diabetes, myocardial infarction, myocardial diseases, smoking,vascular disease and stroke history. Clopidogrel usage has been increasing to 25.63% in 2008, but was far behind high ratio of high risk RIS patients(85.45%). Conclusions This retrospective study showd an increasing trend in RIS risk during 2001-2008. Identifying high risk patients and applying intensified antiplatelet therapy might play an important role in reducing the risk of RIS.

Objective To assess the relationship of serum prealbumin level with the severity of acute ischemic stroke (AIS).Methods The clinical data of 2522 AIS patients who were admitted in Peking Union Medical College Hospital from 2000 to 2008 were retrospectively analyzed.The serum prealbumin and hypersensitive C-reactive protein (hs-CRP) levels were evaluated by immunoturbidimetric assay within 24 hours after admission.The AIS severity was evaluated at admission using modified Rankin Scale (mRS).Patients were divided into mild AIS group (mRS score ≤ 3 ) and severe AIS group (mRS score ＞ 3 ).The levels of serum prealbumin and hs-CRP were compared between these two groups,and the relationship between praalbumin and hs-CRP was also analyzed.Results There were 1697 patients in the mild group (average mRS score:1.67) and 825 patients in the severe group ( average mRS score:4.53 ).The severe group had significantly lower prealbumin level [ ( 191.20,82.00)versus (219.18,72.00) mg/L,P =0.000] and higher hs-CRP level [ (6.01,8.22) versus (4.15,6.93) mg/L,P =0.000 ] than the mild group,respectively.Partial regression analysis showed that the stroke severity was negatively correlated with serum prealbumin level (r =-0.115,P =0.000) and positively correlated with hs-CRP level (r =0.098,P =0.000).Serum prealbumin level was inversely correlated with hs-CRP level ( r =- 0.396,P =0.000).Conclusion The prealbumin level is relevant with the severity of AIS and inflammation.

Objective To investigate the value of CT in localization diagnosis of the neoplasm of the transverse mesocolon.Methods 26 cases of neoplasm of the transverse mesocolon proved by surgical pathology or pathology from May 1998 to Dec.2007 were retrospectivley studied.All cases underwent CT scan.Image analysis was focused on the relation between neoplasm and SMA,SMV,middle colonic vessels,duodenum,and the small bowel.Readipose sarcoma (n=1),transverse colonic carcinoma invaded the transverse melocolon (n=2),pancreatic carcinoduodenum in 22 cases.Superior mesenteric artery and vein were displaced in 21 cases;middle colonic vessels were showed different CT manifestation.Conclusion The relation between neoplasm and adjacent structure is helpful for the localizing neoplasm of the transverse mesocolon.

Objective Mini presentation is a new teaching model, which is performed by interns based on a typical case or disease at the medical ward.The aim of our study is to evaluate the effect of mini presentation on clinical neurologic teaching actions, according to a survey results in the interns.Methods A total of eighty-nine clinical medical students in Peking Union Medical College finally responded to the survey questionnaire, including ten questions regarding the mini presentation.Results 69.23% of the interns and 22.3% of the probationers have performed mini presentation at the neurological wards.Conclusion 43.82% of the students agreed that mini presentation was very necessary.80.9% of the students supported that mini presentation was helpful to their clinical reasoning of the neurology.ConclusionsMini presentation could motivate the independent learning interests of the students, and could improve the teaching quality in neurology.It is worth to practice and popularize further.

Objective: To study therapeutic effects of simvastatin on vascular endothelial cell dysfunction in patients with coronary heart disease (CHD). Methods: According to LDL-C level, a total of 90 CHD patients were divided into simvastatin 20mg group (n=37, LDL-C≥2.5mmol/L), simvastatin 10mg group (n=35, 1.8mmol/L≤LDL-C<2.5mmol/L) and routine treatment group (n=18, LDL-C<1.8mmol/L). Their course of treatment was 8 weeks. Color Doppler ultrasound diagnostic instrument was used to measure flow-mediated dilation of brachial artery (FMD), and nitrate reductase method was used to measure concentration of nitric oxide (NO) in all CHD patients. Serum concentrations of TC, TG, LDL-C and HDL-C were routinely measured. Results: After treatment of eight weeks, compared with before treatment, there were significant decrease in concentrations of TC, TG and LDL-C (P<0.05 all), and significant increase in HDL-C level (P<0.05 all) in simvastatin 20mg and 10mg group, but there were no significant difference in above-mentioned all indexes between simvastatin 20mg and 10mg groups, P>0.05 all; Compared with routine treatment group, there were significant improvement in FMD [(6.01±0.49)% vs. (9.01±0.39)% vs. (9.01±0.47)%，P<0.01 all] and significant increase in serum NO concentration [(38.97±8.89)μmol/L vs. (47.67±10.89) μmol/L vs. (45.61±9.09) μmol/L，P<0.05 all] in simvastatin 20mg and 10mg group; But there were also no significant difference in serum NO and FMD between simvastatin 20mg and 10mg groups, P>0.05 all. Conclusion: Simvastatin can increase NO concentration and improve vascular endothelial cell dysfunction in CHD patients. Its mechanism may be related with lipid-lowering effect, but independent of its lipid-lowering effect