Objective To investigate the diagnostic value of blood homocysteine,ankle -brachial index and brachial -ankle pulse wave velocity in elderly patients with coronary heart disease (CHD).Methods 97 patients with routine coronary angiography were classified into CHD group (65 cases)and non -CHD group (32 cases) according to the results of coronary angiography.There were 24 cases with single -vessel disease in 65 CHD cases, 21 cases with double -vessel disease and 20 patients with multivessel disease of CHD.Basic clinical parameters,age, gender,TC,TG,LDL -C,HDL -C,etc and blood HCY,ABI,baPWV levels were compared among groups.Results The age of double -vessel disease group,multivessel disease group was significantly higher than that in single -vessel disease group(t =3.721,3.927,all P <0.05).HCY,ABI,baPWV in CHD group were (18.29 ±2.73)μmol/L, (0.97 ±0.16),(16.38 ±1.27)m/s,which had statistically significant differences compared with non -CHD group (HCY:t =5.701,P <0.01;ABI:t =6.138,P <0.01;baPWV:t =15.132,P <0.01 ).There were no significant differences between single -vessel disease group and non -CHD group on the ABI(all P >0.05),and the ABI of multi -vessel disease,double vessel disease group were significantly lower than that of non -CHD group (all P <0.01).HCY,baPWV of CHD group were significantly higher than non -CHD group(all P <0.01 ),double vessel disease,HCY multivessel disease group,ABI,baPWV average water with single -vessel disease group were signifi-cantly different(all P <0.01 ).With the increase of coronary lesions involved,the blood HCY,baPWV showed an increasing trend and ABI showed an decreasing trend.Conclusion Combined detection of HCY,baPWV and ABI has great value in early detection and early intervention of CHD in the elderly.

Objective To evaluate the early emergency management process for severe pelvic fractures combined with multiple trauma. Methods The study involved 113 patients with severe pelvic fractures combined with multiple trauma treated from January 2007 to May 2011.The patients were divided into two groups,ie,before trauma team establishment (26 patients treated from January 2007 to May 2008) and after trauma team establishment (87 patients treated from June 2008 to May 2011 ) in accordance with the establishment period of trauma team in June 2008.The mortality was compared before and after application of trauma-team-based algorithm with damage control resuscitation,external fixation and angiographic embolization.Variables including age and gender distribution,ISS score,injury type and mechanism,transportation time,associated injury number,initial systolic pressure hemoglobin and blood transfusion were analyzed for study of their relation with mortality. Results After trauma team establishment,the mortality (23％) was significantly lower than before trauma team establishment (46％).The mortality showed significant relation to ISSN score and over two regions of associated injury,but showed no correlation with age and gender distribution,injury type and mechanism,transportation time initial systolic pressure hemoglobin,and blood transfusion. Conclusion The application of trauma team is effective in treatment of severe pelvic fractures combined with multiple trauma and can decrease the mortality.

Objective To investigate the markers in early diagnosis of acute kidney injury (AKI) in patients undergoing heart surgery.Methods Markers included serum cystatin C (CyC),and urinary neutrophil gelatinase-associated lipocalin(NGAL),interleukin 18(IL-18),retinol binding protein(RBP)and N-acetyl-β-D-glucosaminidase(NAG).Twenty-nine cardiac surgical patients hospitalized were enrolled in the study.Serial blood and urine samples were collected immediately before incision and at various time intervals after surgery.The primary outcome measure was AKI.defined as a 50%increase in Scr from baseline. Results The cohort consisted of 29 patients aged(62.9±13.7)years,and baseline Scr was(73.2±11.9)μmol/L.There were no significant differences in demographics between cases and controls,while the aortic clamp time was predictably longer in AKI cases as compared to controls[(60.63±13.92)vs(43.00±9.20)rain,P<0.05].Each biomarker difiered significantly between cases and controls at least one timepoint.Optimal AUCs were for CyC at 10 houm with sensitivity (ST)0.71,specificity(SP)0.92,AUC=0.83(0.67-1.00),cut-off(CO)1.31 mg/L;NGAL at 0 hour with ST 0.84,SP 0.80,Auc=0.85(0.70-1.00),CO 49.15 μg/g Ucr;IL-18 at 2 hours with ST 0.85,SP 0.73,AUC=0.81(0.64-0.97),CO 285.65 ng/g Ucr;RBP at 0 hour with ST 0.75,SP 0.67,AUC=0.77(0.60-0.95),CO 2934.65μg/g Ucr and NAG at 4 hours with ST 0.86,SP 0.67,AUC=0.72(0.53-O.92),CO 37.05 U/mg Ucr.Using a combination of all the 5 biomarkers analyzed at the optimal time-point as above,an AUC of 0.98(0.93-1.02)(P<0.01)in this limited sample was able to obtain. Conclusions Application of serum and urinary biomarkers for the prediction of AKI in patients undergoing cardiac surgery is highly dependent on the sampling time.Of the evaluated markers,uNGAL has the best predictive profile.uRBP also shows similar predictive power.Combining all the five above biomarkers is able to predict significantly more cases,suggesting that the use of more than one marker may be beneficial clinically.

Objective To investigate the long-term prognosis and possible risk factors of acute kidney injury(AKI)following cardiac surgeries. Methods Clinical data of 941 patients undergoing open heart surgery from January 2004 to June 2007 were retrospectively analyzed.Survival and renal function of above patients were informed through telephone or clinic follow-up till February 2010.Long-term survival was analyzed using risk-adjusted Cox proportional hazards regression model. Results Of the 941 patients after cardiac surgery,275(29.2%)developed AKI and 666(70.8%)did not.Survival was worse in patients with AKI(67.8%vs 85.6%,P<0.01)and was proportional to its severity (AKIN 1,2 and 3 stages:70.7%,62.3%and 58.6%,P<0.01).Although 90.5% of patients had complete renal recovery after AKI at discharge of hospital,they still had an increased risk for death during follow-up compared with patients without AKI (69.6% vs 85.6%,P<0.01).In the Cox proportional hazards regression model,age(HR=2.238),anemia (HR=1.625),prolonged operation time (HR=1.153),AKI severity (HR=1.473)were independent risk factors for long-term prognosis after cardiac surgery.At the end of the follow-up,patients with AKI had statistically higher Scr than non-AKI patients(107.6 μmol/L vs 83.0 μmol/L,P=0.014),and among those AKI patients,34.0%progressed into CKD 3-5 stages,34.8%developed double serum creatinine. Conclusions AKI is a risk factor for the long-term prognosis of cardiac surgery.Patients with complete renal recovery after AKI still has an increased risk for death and poor renal function compared with patients without AKI.

Objective To study human lung adenocarcinoma cell line A-549 treated with antagonist and agonist of potassium channel how to affect metastasis of A-549 and its mechanism. Methods Invasion and migration capability of A-549 in vitro was evaluated by using transwell chamber model. Alteration of cytoskeleton was observed through immunofluorescence. Western blotting were used to detect the protein expression of Ezrin and HuR in A-549 cell lines while Glibenclamde and Pinacidil were applied to them. Results In the presence of the antagonist Glibenclamide, migration of A-549 was inhibited by (57.18±5.46)% and invasion was inhibited by (54.92±3.72)% in the transwell assay, meanwhile A-549 manifested disorder of microtubule and more orderly microfilament. And agonist of the potassium channel had an contrary effect on A-549. Ezrin and HuR protein were successfully down-regulated in A-549 treated with Glibenclamide and upregulated in A-549 treated with pinacidil. Conclusion Functional alterations of the potassium channel affects capability of migration and invision of A-549, which is associated with different expression of ezrin and HuR protein that modify cytoskeleton.

OBJECTIVE:To establish the quality standard of Chushi pill. METHODS:Microscopic identification and TLC were adopted for the qualitative identification of Cortex moutan,C. dictamni,Angelica sinensis,Rubia cordifolia and Gardeniae fructus in Chushi pill;HPLC was performed to determine the contents of paeonol and baicalin. It was performed on column of Kro-masil 100-5 C18 with mobile phase of methanol-water-phosphoric acid(47∶53∶0.2,V/V/V)at the flow rate of 1.0 ml/min,the detec-tion wavelength was 280 nm,the temperature was 25 ℃ and the volume was 10 μl. RESULTS:The microscopic identification showed microscopic characteristics of C. moutan and C. dictamni,and characteristics of A. sinensis,R. cordifolia and G. fructus were identified by TLC;the linear range of paeonol was 0.106 24-2.124 8 μg(r=0.999 9)and baicalin was 0.059 04-1.180 8 μg (r=0.999 9);RSDs of precision,stability and reproducibility tests were no more than 2.06%;average recoveries were respective-ly 101.56%(RSD=1.68%,n=9)and 100.16%(RSD=1.13%,n=9). CONCLUSIONS:The method is simple,accurate and re-producible,and can be used for the quantity control of Chushi pill.

Objective To determine,the clinical significance of serum myocardial enzymes (Mb,cTNI, CK,CK-Mb,AST,LDH) in the classification of the disease severity of non-cardiogenic critically-ill patients. Compared with APACHEⅡscore concerned as the standard diagnosis of the critical ills,these biomarkers were investigated for the evaluation possibility of the degree and the prognosis of the critical ills.Method Patients admitted to our EICU were consecutively collected for the research from April to December in 2005 and the myocardial enzymes,and routine serum biochemical test and APACHEⅡscore were detected simultaneously.All the patients were classified to three groups according to the APACHEⅡscore (mild group,APACHEⅡ25) and two groups (survive group and death group) according to the prognosis.All the patients were followed up till recovery/discharge or death. Covariance,Wilcoxon and x~2 were used for the statistical analysis.Results The myocardial enzymes rose when the disease deteriorated and the APACHEⅡscore went up.AST,LDH,CK,CK-Mb,Mb were significantly different in the three groups according to the APACHEⅡscore (P

Objective To prospectively investigate the value of urinary neutrophil gelatinase-associated lipocalin (NGAL) in the diagnosis of acute kidney injury (AKI) following adult cardiac surgery. Methods Twenty-nine hospitalization patients undergone cardiac surgery were enrolled in the study. Serial blood and urinary samples were collected immediately before incision and at various time intervals after surgery. The primary outcome measure was acute kidney injury, defined as a 50% increase in the level of serum creatinine (Scr) from baseline. Results Fourteen of 29 developed acute kidney injury. The diagnosis time point with Ser was at 24 (10, 48) h after cardiac surgery. By contrast, the concentration of urinary NGAL rose from a median of 3.42(1.60, 9.92) μg/L at baseline to 20.51(13.42, 50.02) μg/L at admission to ICU (P=0.006),and the median concentration of urinary NGAL in patients who developed AKI was significantly higher at admission to ICU compared with patients who did not develop AKI [20.51 (13.42, 50.02) μg/L vs 2.91 (0.72,8.61) μg/L, P=0.002]. As to urinary NGAL at admission to ICU, the area under the receiver-operating characteristic (ROC) curve was 0.824, the sensitivity was 85.7% and the specificity was 80.0% with a cutoff value of 10.95 μg/L. Significant correlation was found between urinary NGAL at admission and the levd of Scr at 24 h in ICU (r=0.545, P=0.002), as well as estimated GFR (r=-0.546,P=0.002). Conclusion Urinary NGAL concentration is significantly higher in patients developing postoperative AKI at the early time of admission to ICU, which may be a useful early biomarker of AKI after adult cardiac surgery.

Objective To compare the consistency of immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) in detecting c-erbB-2 status in breast cancer tissues. Methods A total of 50 breast cancer paraffin embedded samples were selected, of which there were 10 cases of c-erbB-2 protein expression (+), 20 cases of (++) and 20 cases of (+++). FISH was used to assess the amplification of c-erbB-2 gene, and SPSS 13.0 software was employed to analyze the difference and consistency between the two methods. Results IHC and FISH methods had a good consistency when detecting c-erbB-2 (+) and (+++) expressions in breast cancer tissues, with the coincidence rate of 89.2%. However, when IHC was used to test c-erbB-2 (++), the result of FISH was quite different, with the coincidence rate of only 35.3%. Conclusion IHC is a preliminary method to detect c-erbB-2 status in breast cancer. IHC and FISH methods have a good consistency in detecting c-erbB-2 (+) and (+++) status in breast cancer tissues. As detection of c-erbB-2 (++) with IHC has a different result from FISH, such patients should receive FISH confirmation for herceptin therapy.

Objective To compare the RIFLE and AKIN diagnosis criteria for acute kidney injury ( AKI) in patients undergoing cardiac surgery. Methods Patients undergoing cardiac surgery from January 2004 to June 2007 were retrospectively evaluated. RIFLE and AKIN criteria were employed for the diagnosis and staging of AKI which occurred 7 d after cardiac surgery. The diagnosis sensitivity and precision for prediction of hospital mortality were compared between these two criteria. Results One thousand and fifty-six patients were included in this study. There was no significant difference between the prevalence of AKI after cardiac surgery diagnosed by RIFLE criteria and that diagnosed by AKIN criteria (29.55% vs 31.06%, P>0.05). There was no significant difference between the total hospital mortality and the hospital mortality of each stage of AKI diagnosed by RIFLE criteria and those diagnosed by AKIN criteria ( P > 0. 05). Logistic regression analysis suggested that the relative risk of hospital mortality for AKI was similar between patients diagnosed by AKIN criteria and those diagnosed by RIFLE criteria. The area under the ROC curve for hospital mortality was 0. 856 for RIFLE and 0.865 for AKIN in all patients (P<0.001). Conclusion Compared to RIFLE criteria, AKIN criteria do not improve the sensitivity of diagnosis and predictive ability of hospital mortality of AKI after cardiac surgery.