Obiective To detect the carotid-femoral pulse wave veloeity(CF-PWV) and evaluate relation in pulse pressure (PP) and pulse wave velocity ('PWV), and prove the effect of dynamic error analysis system on pulse wave velocity measure. Methods 486 cases with essential hypertension were detected with carotid-femoral pulse wave velocity. The dynamic error was controlled in three kinds of condition: 15%>error>10%, 10%>error>5% and 5%>error, which PWV values were tested repeatedly with the effect of different errors observed. At the same time the blood pressure was measured and the pulse pressure was calculated. Results The pulse wave velocity which pulse pressure ≥60mm Hg (1mm Hg=0.133 kPa) was significantly higher than pulse pressure <60turn Hg [(14.2± 2.34)m/s and (8.5±1.81)m/s, P<0.001] . Pulse wave velocity and pulse pressure and age showed a significant positive correlation (pulse pressure r=0.529, P=0.000; age r= 0.331 P=0.003).When dynamic error is more than 10% and less than 15%, the diversity of PWV values showed the significance of statistics. Conclusion The effect of dynamic error analysis system on pulse wave velocity measure, less error test pattern is advantageous to enhance accuracy. The pulse pressure is closely related to pulse wave velocity. Arterial pulse wave velocity is a new evaluation of the indicators of arterial stiffness, and it's more scientific, accurate and eonvenient.

Objective To study the difgerence between the IAEA code of practice TRS-Z77 and TRS-398 in the determination of the absorbed dose to water for high-energy photon beams using several cylindrical chambers. Methods For 6 different types of cylindrical chambers,the calibration factors ND,W,Q0 in terms of absorbed dose to water were calculated from the air exposure calibration factors N,,and were compared with the ND,W,Q0 measured in European standard laboratory. Accurate measurements were performed in Varian 6 MV photon beam using 6 cylindrical chambers according to TRS-277 and TRS-398.The beam quality correction factors kQ.Q0 as well as the water absorbed doses were compared.Results For the set of chambers,the difference between ND,W,Q0 computed from Nx and ND.-.Q0 obtained in European standard laboratory was 0.13％ ～ 1.30％.The difference of beam quality correction factors for TRS-277 and TRS-398 was 0.09％ ～0.45％.The distinction of the water absorbed doses obtained according to the two different protocols was 0.27％ ～ 1.40％,and was primarily due to their different calibration factors.Conclusions The discrepancy in absorbed doses determined according to two protocols using different cylindrical chambers is clinically acceptable.However,TRS-398 allows a more convenient localization of chambers,provides a more simple formulation,and offers the reduced uncertainty in the dosimetry of radiotherapy beams.

Objective To summarize the modified clinical technique and experience of simultaneous kidney-pancreatic transplantation (SKPT) with enteric drainage(ED). Methods Two patients with insulin-dependent diabetes mellitus and end-stage renal disease underwent SKPT with enteric drainage of exocrine secretions.The patients were treated with quadruple therapy including antithymocyte globulin (ATG) induction therapy,prednisone,FK506,and Mycophenolate-Mofetil(MMF), as maintenance immunosuppression. Results The two patients became insulin-independent after treated by small dose insulin for 5～10 days and Scr,BUN became normal 3～5 days after the operation.Until now all the grafts of the patients functioned well. Conclusions ED-SKPT is more effective than simultaneous kidney-pancreatic transplantation with bladder drainage (BD-SKPT).ED-SKPT is an effective method for treating type Ⅰdiabetes mellitus with uremia.Finer allograft and nicer HLA-typing can decrease complications.

OBJECTIVE:To analyze the general features of adverse drug reactions(ADRs)caused by hepatitis B vaccine.METHODS:72national case reports of ADRs induced by hepatitis B vaccine in recent10years were classified and analyzed statistically.RESULTS:The affected patients ranged in age from1year to 40 years,with more males than females;Most ADRs occurred with in 30 minutes after the medication;The ADRs were characterized by allergies in clinic,even allergic shock.CONCLUSIONS:It is important to manage the ADRs caused by hepatitis B vaccine for the safety of medication.

Objective To explore the feasibility and safety of endoscopic thyroidectomy via axillo-breast approach and the cervical strap muscles. Methods From January to June 2007, endoscopic thyroidectomy was performed on 21 cases in our department via axillo-breast approach and the cervical strap muscles. The operation was carried out under general anesthesia, the anterior cervical muscles was preserved and dragged ahead if necessary. The pressure of CO2 at surgical space was set at 6-8 mm Hg.Results Endoscopic unilateral partial or subtotal thyroidectomy was completed in all the patients without converting to open surgery. No complication occurred in this series. The mean operation time was 70-120 min [mean,(88.3?19.5) min], and the mean blood loss was 2-100 ml [mean, (11.5?21.8) ml]. The drainage tube was removed at 36-48 hours after the operation. And the mean postoperative hospital stay was 2 days. A 3-month follow-up showed good outcomes in terms of sensation at the surgical region and cosmetic effect. Conclusion Endoscopic thyroidectomy via axillo-breast approach and the cervical strap muscles is feasible and safe for unilateral benign thyroid lesions.

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 understand the dynamic status of schistosomiasis epidemic situation and Oncomelania hupensis snail status before and after the schistosomiasis transmission interrupted in the mountainous areas of Yunnan Province. Methods The data of schistosomiasis epidemic situation and snail status were collected and analyzed statistically in Jianchuan County from 10 years before the schistosomiasis transmission interrupted to 2008. Results The schistosomiasis control began in Jianch-uan County from 1954. In 1976,the criteria of schistosomiasis endemic controlled were reached,and the infection rate of popu-lation was 0.65%and the infection rate of snails was 0.40%. In 1981,the criteria of schistosomiasis transmission controlled were reached,and the infection rate of population was 0.34%and the infection rate of snails was 1.41%. In 1993,the criteria of schis-tosomiasis transmission interrupted were reached,and the infection rate of population was 0 and the infection rate of snails was 0. There was a fluctuation in the schistosomiasis epidemic situation and snail status during the whole control duration ,but the trend was decreasing. Conclusion The time from schistosomiasis endemic controlled to transmission controlled is relatively short,but the time from transmission controlled to transmission interrupted is relatively long. In the original schistosomiasis en-demic areas,there might be some areas where there is no the disease bud there still are snails.

Objective To explore the clinical outcomes of treatment conversion from cyclosporine A (CsA) based immunosuppression to a new agent tacrolimus (FK506) after kidney tansplantation due to the side effects of CsA. Methods Forty eight cases of kidney transplantation who were diagnosed having CsA hepatoxicity,10 cases having gingival overgrowth,16 cases having hirsuties,and 13 cases having hyperlipidemia were treated with tacrolimus (FK506) in place of CsA.The initial dose of tacrolimus was administered according to the patient's body weight,liver function and time of post operation.The dosage of tacrolimus was adjusted according to its trough level,and the blood levels of tacrolimus were sustained to 8～10 ?g/L within 6 months after operation,6～8 ?g/L within 1 year and 4～6 ?g/L 1 year later.The liver function, renal function,serum lipids level,whole blood FK506 trough concentration,immunosuppressive index and clinical symptoms were closely monitored. Results In 47 of 48 patients who had CsA hepatoxicity and then were treated with FK506 in place of CsA,the liver function became normal 10～48 days later.Only one patient died of liver failure after treatment switch to FK506.All of the 10 patients experienced significant resolution of their gingival enlargement within the time period studied,however only 6 of them had complete regression.All the 16 recipients with hirsuties benefited from replacing CsA with tacrolimus,and were cured after the switch.Lipids levels decreased significantly in the 13 recipients with hyperlipidemia after conversion to tacrolimus. Creatinine levels remained stable and no acute rejection was observed in the study. Conclusions Treatment conversion from CsA to tacrolimus is safe and effective in recipients with hepatic dysfunction,hyperlipidemia or hirsuteness,gingival overgrowth after renal transplantation.The conversion from CsA based immunosuppression to tacrolimus has less side effects and no increase in rejection rate in renal transplant recipients.

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 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.