Objective To explore CTA characteristics of diabetic lower extremities arterial disease (LEAD) with different Fontaine stage.Methods Data of 100 patients clinically diagnosed as diabetic LEAD and underwent lower limbs arterial CTA were analyzed retrospectively.The patients were classified into grade Ⅰ-Ⅳ according to Fontaine classifications.Lower extremities arteries were graded according to CTA.Stenosis degree of lower extremity arteries in different Fontaine stages were analyzed.Results The grades of lower extremity arteries stenosis in different Fontaine stages had statistically significant difference (x2 =186.24,P＜0.001).There had statistically significant difference of stenosis degree in different lower extremity arterial levels among different Fontaine stages (superior genicular artery:x2 =69.24,P＜0.001;inferior genicular artery:x2 =111.59,P＜0.001;dorsalis pedis and arteriae plantaris:x2 =94.15,P＜0.001).Grades of stenosis between superior genicular arteries and inferior genicular arteries,superior genicular arteries and dorsalis pedis and arteriae plantaris had statistically significant differences (Z=12.59,P＜0.001;Z=10.47,P＜0.001).There was statistically significant difference of stenosis grades between inferior genicular artery and dorsalis pedis and arteriae plantaris (Z=12.66,P＜0.001).Occluded inferior genicular arteries usually associated with collateral vessels.Conclusion CTA can reflect the clinical stages of LEAD,which is the ideal method in diagnosing of diabetic LEAD.

Objective:To conduct health economic evaluation of Chinese population-based screening and opportunistic testing strategies for the prevention of Helicobacter pylori ( H. pylori)-related diseases. Methods:The Markov models of H.pylori infection caused non-ulcer dyspepsia, peptic ulcer (PU) and gastric cancer were established. The cost and effects of the population-based screening, opportunistic testing, and non-intervention strategies in 100 000 population of our country were simulation calculated. Wilcoxon signed rank test was used for statistic analysis. Single factor sensitivity analysis was performed to analyze the impact of single parameter uncertainty on cost-effectiveness. Probability sensitivity was used to analyze the impact of common uncertainty of all parameters on cost-effectiveness. Results:Compared with opportunistic testing strategy and non-intervention strategy, the total cost of population-based screening strategy was reduced by 0.43 million yuan(-6.63 million yuan to 7.19 million yuan) and 4.45 million yuan(-8.60 million yuan to 27.93 million yuan), quality adjusted life years (QALY), life years and asmptomatic months were prolonged by 888.00 (479.86 to 1 574.10) and 3 032.78 (1 756.04 to 5 007.84), 651.82 (294.73 to 1 211.94) and 1 868.64 (1 045.88 to 3 148.34), 28 381.91 (19 109.54 to 43 736.72)and 102 537.13 (58 649.18 to 176 868.77) respectively, gastric cancer, deaths from gastric cancer, deaths from PU and deaths from various causes were reduced by 115 cases(52 cases to 232 cases) and 464 cases(266 cases to 803 cases), 74 cases(33 cases to 148 cases) and 260 cases(149 cases to 453 cases), 46 cases(25 cases to 72 cases) and 369 cases(210 cases to 710 cases), 80 cases(42 cases to 126 cases) and 501 cases(331 cases to 772 cases) respectively, and the differences were statistically significant ( Z=1.99, 10.54, 27.39, 27.39, 27.37, 27.39, 27.39, 27.39, 27.21, 27.28, 27.22, 27.28, 27.38, 27.39, 27.39 and 27.39, all P<0.05). Compared with the non-intervention strategy, the opportunistic testing strategy reduced the total cost by 3.89 million yuan(-2.79 million yuan to 18.18 million yuan), QALY, life years and asymptomatic months were prolonged by 1 764.77 (888.70 to 3 406.62), 1 044.16 (524.46 to 1 912.75) and 62 568.69 (30 054.07 to 129 892.76) respectively, gastric cancer, deaths from gastric cancer, deaths from PU and deaths from various causes were reduced by 311 cases(164 cases to 563 cases), 164 cases (87 cases to 301 cases), 325 cases(162 cases to 644 cases) and 399 cases(234 cases to 684 cases) respectively, and the differences were statistically significant ( Z=14.20, 27.39, 27.38, 27.39, 27.25, 27.25, 27.39 and 27.39, all P<0.01). The results of singlefactor sensitivity analysis showed that the uncertainty of any parameter did not affect the cost-effectiveness of three strategies. The results of probability sensitivity analysis indicated that the probability of cost-effectiveness advantage of the population-based screening strategy was 100% and the common uncertainty of all parameters had no effect on cost-effectiveness. Conclusions:For preventing H.pylori-related diseases, the population-based screening strategy has the lowest average cost and the best average effect. However, non-intervention strategy has the highest average cost and the worst average effect. Population-based screening strategy is worthy of promotion throughout China, and opportunistic testing strategy has a higher clinical practical value.

OBJECTIVETo investigate the effects of advanced glycosylation end products (AGEs) modified bovine serum albumin (AGE-BSA) on the expression of reactive oxygen species (ROS) and monocyte chemoattractant protein-1 (MCP-1) in human renal mesangial cells (HRMCs).

METHODSHRMCs were cultured in vitro with medium containing different doses of AGE-BSA or BSA (50,100, 200, 400 mg/L) for 48 hours, or with AGE-BSA (200 mg/L) for different times (12, 24, 48, 72 h). Immunocytochemistry assay was used to estimate the protein level of RAGE. The ROS in cells were measured by flow cytometry and the mRNA expression of MCP-1 were analyzed by semi-quantiative reverse transcription-polymerase chain reaction (RT-PCR) after treatment with AGE-BSA or BSA.

RESULTSThe protein level of RAGE was upregulated in the HRMCs with AGE-BSA. The expression of ROS and MCP-1 significantly enhanced by incubation of AGE-BSA in a time- and dose-dependent manner. The effects of AGE-BSA-induced up-regulation of ROS and MCP-1 level was significantly blocked by neutralizing antibodies to RAGE, while the expression of ROS and MCP-1 stood nearly unchanged after cultured with huamn IgG.

CONCLUSIONThe expression of ROS and MCP-1 in HRMCs is induced by AGE-BSA through RAGE, which may have potential effects in the pathgenic mechanism of diabetic nephropathy.

Cells, Cultured ; Chemokine CCL2 ; metabolism ; Glycation End Products, Advanced ; pharmacology ; Humans ; Mesangial Cells ; drug effects ; metabolism ; Oxidative Stress ; drug effects ; Reactive Oxygen Species ; metabolism ; Receptor for Advanced Glycation End Products ; Receptors, Immunologic ; metabolism ; Serum Albumin, Bovine ; pharmacology

Objective To explore the cognitive status of amyotrophic lateral sclerosis (ALS) patients, and to explore the involved cognitive domains, subtypes and risk factors of mild cognitive impairment in ALS ( ALS-MCI).Methods Twenty-nine cases of ALS and 58 healthy volunteers were included.The severity of the bulbar and spinal functions of the patients was evaluated by the Improved Norris Scale.According to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition-Revised( DSM-Ⅳ-R) criteria of dementia, ALS cases were classified as demented and non-demented.For non-demented ALS cases, the common cognitive batteries evaluating mental state, verbal memory, executive, attentional and visuospatial abilities were performed.Hamilton Anxiety Scale ( HAMA) and Hamilton Depression Scale (HAMD) were evaluated too.They were further classified into ALS-cognitively normal (ALS-CogNL) and ALS-MCI groups according to Petersen criteria of MCI.Risk factors possibly correlated with ALS-MCI were analyzed by comparing the differences in age, age of onset, duration of the disease, sites of onset, symptoms of bulbar and limb function between ALS-CogNL and ALS-MCI groups.Results Among 29 ALS cases, 14 (48.3% ) cases with cognitively normal( ALS-CogNL), 15 cases (51.7% ) with ALS-MCI,and none with dementia were identified.Among 15 ALS-MCI cases, 12 cases with executive dysfunction, 8 cases with memory deficits,9 cases with attention impairment and none with visuospatial impairment were found.ALSMCI cases could be further classified into three subtypes; 1 case with amnestic MCI (aMCI) ,6 cases with single domain non-memory MCI ( sdMCI), and 8 cases with multiple domains slightly impaired MCI (mdMCI).Between ALS-MCI and ALS-CogNL groups, there were significant differences (t = -2.435,- 2.576, both P ＜ 0.05) in education ((8.7 ± 2.8) years vs (11.3 ± 3.0) years) and Improved Norrisscale (bulbar score: (28.4 ± 7.7) scores vs ( 34.0 ± 3.4) scores) , however, no significant differences in sex, age, age of onset, duration,site of onset,HAMA or HAMD scores,and Improved Norris scale( spinal score) were found.Conclusions Cognitive deficits commonly exist in ALS patients.For the involved domains, executive dysfunction is the most common, deficits of attention and memory are also common, and deficit in visuospatial function is not found.The most common subtype of ALS-MCI is mdMCI.Severe bulbar symptoms and lower education may be the risk factors of ALS-MCI.

Objective To study the ultrastructure of the renal papillary Randall's plaque in calclum oxalate stone formers. Methods The 14 biopsy samples of the Randall's plaque in 12 patients with calcium oxalate stone undergoing PCNL for stone removal were obtained using endoscopic biopsy technique,followed by staining with hematoxylin-eosin or fixing with osmium tetroxide,and then the ultrastructure of the Randall's plaque was observed under light microscope and transmission electron microscope. Results In all 12 patients,72 renal papillae were examined.All kidReys were found to have papillary plaque and 7 of the patients had attached stones.Sixty-three papillae(87.5%)contained plaque.Calcium deposition was seen in the 12 renal papilla tissue by light microscopy.Transmission electron microscopy images of the 2 Randall's plaque samples showed several cluster of sharp and large crystals lied closer to the surface of Randall's plaque.The typical crystals were acicular with light profile. Conclusions Randall's plaque is an interstitial medullary and papillary deposit of calcium oxalate.The appearance of the deposition of calcium oxalate crystals lies upon Randall's plaque,which might be an explanation for the mechanism of calcium oxalate stone formation.

OBJECTIVETo study the related risk factors for surgical site infection following Pilon fracture surgery. METH ODS: The data of 561 patients with Pilon fractures treated with open reduction plate osteosynthesis at our institution's trauma centre were collected from January 2006 to December 2012. All the patients were divided into two groups: infection group and non-infection group. In the infection group, there were 23 males and 10 females, ranging in age from 21 to 69 years old, with an average of (45.50±4.40) years old. In the non-infection group, there were 296 males and 232 females, ranging in age from 16 to 76 years old, with an average of (43.50±7.19) years old. The possible risk factors such as age, gender, smoking, diabetes, alcohol abuse, open fractures, compartment syndrome and operative time were studied. The multivariate Logistic regression model was used to analyze the risk, factors.

RESULTSThe infection rate of surgical site after Pilon fracture surgery was 5.88%. There were significant statistical differences between infection group and non-infection group in operative time, open fractures and compartment syndrome. However, multivariate Logistic regression analysis revealed that only operative time was significantly associated with surgical site infection (P=0.005, OR=44.92).

CONCLUSIONOperation time is an independent predictor for post-operative surgical site infection of Pilon fracture treated with open reduction plate osteosynthesis. Though open fracture and compartment syndrome could increase the surgical site infection rate, they could not not be considered as independent predictors.

Adult ; Compartment Syndromes ; complications ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Operative Time ; Risk Factors ; Surgical Wound Infection ; etiology ; Tibial Fractures ; surgery

Objective To explore the inhibiting effect of valsartan and spironolactone on cardiac fibrosis and the expression of integrin ? 1 and fibronectin in the heart of spontaneously hypertensive rats. Methods Eighteen 6 week old SHR were randomly divided into 3 groups with 6 in each: SHR control group, valsartan treating group(30 mg?kg -1 ?d -1 ) and spironolactone treating group ( 20 mg?kg -1 ?d -1 ). Six homogenous male WKY rats served as normal group. After 14 weeks of treatment, systolic blood pressure, left ventricular mass, the ratio of left ventricular mass to body weight (LVM/BW), collagen volume fraction(CVF) and perivascular collagen area(PVCA) were determined and compared among these groups. The expression of integrin ? 1 and fibronectin were also examined by immunohistochemical method. Results Compared with the untreated SHR S, systolic blood pressure was significantly decreased in both treatment groups. LVM/BW〔(2 84?0 14)?10 -3 vs(3 22?0 15)?10 -3 〕, CVF〔(3 21?0 22)%vs(4 00?0 28)%〕, PVCA〔(0 62?0 15)%vs(0 94?0 56)%〕 were lower in both treatment groups, these parameters in SHR V group were even lower than those in SHR S group. Compared with the untreated SHR S, the expression of integrin ? 1 was significantly reduced in SHR V group, while the expression of fibronectin was markedly reduced in both treatment groups. Conclusions Both valsartan and spironolactone could control blood pressure, and effectively inhibit the cardiac fibrosis. Valsartan could also inhibit the expression of cardiac integrin ? 1 and fibronectin, which might be the reason that valsartan is better than spironolactone in inhibiting cardiac fibrosis.

Objective To investigate the effect of formative assessment on skill acquisition of basic life support (BLS) among medical students. Methods Totally 206 undergraduates were ran-domized into control group (C group) and interventional group (F group). A BLS lecture was given in both groups. And then, 45 min BLS training and BLS skill assessment (after training) were given in C group. Undergraduates in F group received BLS skill assessment (formative assessment) before training, and 15 min feedback was delivered based on the assessment, then 30 min BLS training was conducted. Skills assessment was conducted again in F group after the training. Student's-t-test was used to compare the difference of skills between the two groups and P<0.05 signifies statistically sig-nificant differences. Results Score of F group (85.2±7.3) were higher than that in C group (68.2± 13.2), with statistical difference. Conclusion A formative assessment could significantly improve skill acquisition of BLS among medical students.

OBJECTIVETo study the expression of DJ-1 in human hepatocellular carcinoma and its relationship with tumor invasion and metastasis.

METHODSReverse transcription polymerase chain reaction (RT-PCR) and immunohistochemical methods were used to detect the expression of DJ-1 mRNA and protein in tumor tissue and para-tumor tissue of 46 cases of hepatocellular carcinoma. The relationship between the expression of DJ-1 and clinicopathologic parameters was analyzed.

RESULTSDJ-1 mRNA and protein were expressed in 69.6% and 58.7% of the tumor tissues, which were significantly higher than those in para-tumor tissues (39.1% and 34.8%), chi2 = 8.587, P < 0.05. The increased expression of DJ-1 protein was not correlated with sex of patients, size of tumor, AFP, HBsAg, differentiation level of tumor and hepatocirrhosis (P > 0.05), but with the capsula of tumor, thrombus in the portal vein (P < 0.05).

CONCLUSIONSDJ-1 gene expression may play an important role in the invasion and metastasis of HCC.

Biomarkers, Tumor ; genetics ; metabolism ; Carcinoma, Hepatocellular ; genetics ; metabolism ; pathology ; Gene Expression Regulation, Neoplastic ; Humans ; Immunohistochemistry ; Intracellular Signaling Peptides and Proteins ; genetics ; metabolism ; Liver Neoplasms ; genetics ; metabolism ; pathology ; Neoplasm Invasiveness ; Neoplasm Metastasis ; Oncogene Proteins ; genetics ; metabolism ; Protein Deglycase DJ-1 ; RNA, Messenger ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction