Since 2007, a number of published population-based studies have shown that stroke epidemiology has changed. There are some differences in morbidity, mortality, risk factors and clinical prognosis of stroke between the high-income countries and the less developed countries.

Objective To investigate the effects of atorvastutin on the levels of plasm imflammation markers (hs - CRP, MMP - 3, TNF - α) and intima - media thickness(ITM) of the common carotid artery in patient with hyperlipidemic and atherosclerosis. Methods Fifty patient with hyperlipidemic and atherosclerosis were treated with atorvastatin (10mg qd) for 12 weeks. The levels of TC, TG, LDL -C, HDL -C, hs -CRP, TNF -α and MMP -3 were detected with radioimmmuneassay and eolorimetric methods. Color Doppler echo-cardiography was used to measure intima -media thickness(ITM) of the common carotid artery after 6 weeks and 12 weeks. Results TC, TG, LDL -C, hs -CRP, TNF -α and MMP -3 were decreased significantly(P < 0.01)after 12 weeks. IMT was decreased signifi-cantly(P < 0.05) and HDL - C was increased significantly (P < 0.05) after 12 weeks. Conclusion Atorvastatin could be effective in re-ducing blood - fat and anti - inflammatory action , regulating blood vessel endothelium (BVE) function and reversing structural chan-ges in IMT of the common carotid artery.

Salvianolic acid A (Sal A) is one of the most effective compounds isolated from the root of Salvia miltiorrhiza. Up to now, several studies regarding the pharmacokinetic profiles of Sal A have been reported, however there is no such study reported in monkeys, the species which is more similar to human. The aim of this study is to develop a LC-MS method for the determination of Sal A in monkey plasma and apply it to the pharmacokinetic studies of monkeys. After single intravenous administration of Sal A, the plasma concentration-time curves were observed and the main pharmacokinetic parameters were calculated. The plasma concentration at 2 min (C2 (min)) values were (28.343 ± 6.426), (45.679 ± 12.301) and (113.293 ± 24.360) mg x L(-1) for Rhesus monkeys treated with Sal A at 2.5, 5 and 10 mg x kg(-1). The area under the concentration-time curve (AUC(0-∞)) values were (3.316 ± 0.871), (5.754 ± 2.150) and (13.761 ± 2.825) μg x L(-1) x h, respectively. Furthermore, this method was improved and applied to the simultaneous determination of Sal A, Sal B and Sal C, which provided useful information for preclinical studies and clinical trials of Sal A, Sal B and Sal C.
Administration, Intravenous ; Animals ; Caffeic Acids ; pharmacokinetics ; Chromatography, Liquid ; Drugs, Chinese Herbal ; pharmacokinetics ; Lactates ; pharmacokinetics ; Macaca mulatta ; Mass Spectrometry ; Plant Roots ; chemistry ; Salvia miltiorrhiza ; chemistry

Objective To describe the treatment experience of post-operative complications after total arch replacement for acute type A aortic dissection in 34 cases.Methods The subjects were 34 consecutive patients (Twenty-eight males and 6 females,age 34.0 -60.0 yrs) who received total arch replacement for acute Stanford type A aortic dissection from Jan.2005 to Oct.2010 in our hospital.The duration from the onset of the symptoms to the hospitalization ranged from 4 - 18 hrs.Pre-operative 2-D Echo revealed aortic valve regurgitation in 8 patients and mitral valve regurgitation in 1 patient.Results Three patients died after operation ( mortality 8.8％ ).Severe complications included acute kidney injury in 13 cases,respiratory dysfunction in 12 cases,paraplegia in 1 case,mental disorder in 10 cases and excessive post-operative bleeding in 2 cases.Conclusion The incidence of the complications after total arch replacement is still high and severe.Intensive care should be stressed peri-operatively and early diagnosis and treatment for post-operative complications are important procedures.

Objective To evaluate the clinical significance of the change of serum matrix metalloproteinases (MMP)-1,-2,-3 and -9 in acute and chronic aortic diseases and acute myocardial ischemia.Methods The blood serum levels of MMP-1,-2,-3 and -9 were detected in 30 patients with acute aortic dissection,19 patients with chronic aortic dissection,19 patients with aortic aneurysm and in 12 patients with acute myocardial ischemia,as well as in 16 healthy individuals who served as the control group.Serum MMP levels were measured by using an ELISA technique.Results There were significantly higher levels of MMP-3 in patients with acute myocardial ischemia as compared to acute aortic dissection ( [19.10 ± 3.11 ] μg/L vs [11.89 ± 1.31 ] μg/L,P =0.02).Significantly lower levels of MMP-1 were found in healthy controls compared to the groups of patients ( [1.30 ± 0.56 ] μg/L vs [2.99 ± 0.78 ] μg/L in acute aortic dissection,P =0.03,[3.12 ±0.78] μg/L in chronic dissection,P =0.02,[3.01 ± 1.01 ] μg/L in thoracic aortic aneurysm,P =0.03 and [5.01 ± 0.98 ] μg/L in acute myocardial ischemia,P =0.01 ).Higher levels of M MP-1 and MMP-3 were detected on males.There was a positive correlation between MMP-1 and increasing age ( r =0.38,P ＜ 0.05 ).In patients operated for acute type A aortic dissection,the levels of MMP-1,MMP-3 and MMP-9 increased immediately after surgery,while the levels of MMP-2 decreased.Twenty-four hours after surgery levels of MMP-1,-2 and -9 were almost equal to the preoperative ones( P ＞ 0.05 ).Conclusion Measurement of serum MMP levels in thoracic aortic disease and acute myocardial ischemia is a simple and relatively rapid laboratory test that could be used as a biochemical indicator of aortic disease or acute myocardial ischemia,when evaluated in combination with imaging techniques.

Objective To evaluate the efficacy of discriminant function analysis for pericolic infiltration in colorectal cancer on enhanced 64-slice spiral CT and to improve the diagnostic accuracy and specificity of pericolic infiltration. Methods Dynamic enhanced 64-slice spiral CT was performed in 49 colorectal cancer patients (49 masses in total) before surgery. One or two slices were selected for each mass, with a total of 96 slices. The 96 slices were classified into two groups (pericolic infiltration or nonpericolic infiltration group) according to pathological data. Discriminant analysis was performed on the CT values between the mass and the corresponding pericolic tissue 5 mm from the mass at different time points as follows; 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, and 75 s. The discriminant function was calculated, and the pericolic infiltration determined by discriminant function and CT morphology were compared with the pathological results. The CT values in pericolic and non-pericolic infiltration groups at different enhancement time points were assessed using analysis of variance. Results The mean CT values ranged from (43. 6 ±7. 8) HU to (52. 3 ±0. 8) HU in the pericolic infiltration group, and ranged from (100.4±20.3)HU to(116.2±21.4)HU in the non.perieolic infiltration group.At 20 s and 40 s,the mean CT vshle8 were(43.6±27.8)HU and(50.9±27.8)HU in the perleolic infiltration group, (102.0±16.9)HU and(116.2 ±21.4)HU in the non-perieolic infiltration group,respectively.The mean CT value in the pericolic infiltration group was significantly lower than that in the non-pericolic infiltration group at all contrast enhancement time points(F=6.278,P<0.01).A diseriminant function Was obtained as follows:D=-3.450+0.023Xl±0.017X2-0.00lX12-0.001X22+0.002X1×X2. Based on the CT morphology of colorectal cancer,69 slices were identified correctly and 27 slices were fulsely interpreted.the sensitivity.speeificity and accuracy for perieolic infiltration determination were 82.5%,64.3%and 71.9%.respectively.Based on diseriminant function,85 slices were identified correctly and 11 slices were falsely interpreted.the sensitivity,specificity and accuracy were 85.0%.91.1%and 88.5%,respectively.Conclusion The discriminant function with dynamic enhanced 64-slice spiral CT can improve the diagnostic accuracy and specificity of perieolic infiltration in eolorectal cancer patients.

Salvianolic acid A (Sal A) is one of the most effective compounds isolated from the root of Salvia miltiorrhiza. Up to now, several studies regarding the pharmacokinetic profiles of Sal A have been reported, however there is no such study reported in monkeys, the species which is more similar to human. The aim of this study is to develop a LC-MS method for the determination of Sal A in monkey plasma and apply it to the pharmacokinetic studies of monkeys. After single intravenous administration of Sal A, the plasma concentration-time curves were observed and the main pharmacokinetic parameters were calculated. The plasma concentration at 2 min (C2 (min)) values were (28.343 ± 6.426), (45.679 ± 12.301) and (113.293 ± 24.360) mg x L(-1) for Rhesus monkeys treated with Sal A at 2.5, 5 and 10 mg x kg(-1). The area under the concentration-time curve (AUC(0-∞)) values were (3.316 ± 0.871), (5.754 ± 2.150) and (13.761 ± 2.825) μg x L(-1) x h, respectively. Furthermore, this method was improved and applied to the simultaneous determination of Sal A, Sal B and Sal C, which provided useful information for preclinical studies and clinical trials of Sal A, Sal B and Sal C.

Objectives To investigate the prevalence of heterogeneous vancomycin intermediate Staphylococcus aureus(hVISA) and the sensitivity of hVISA to novel antibiotics,and to explore the risk factors and infection attributable mortality associated with hVISA infection.Methods A total of 456 methicillin resistant Staphylococcus aureus (MRSA) isolates were isolated in Zhongshan Hospital from January,2008 to November,2010.All MRSA isolates were investigated for hVISA by two agar screening methods BHIA5T (brain-heart infusion containing teicoplanin 5 mg/L)or BHIA6V (brain-heart infusion containing vancomycin 6 mg/L),as well as macroEtest method(MET).Possible hVISA isolates were tested by modified population analysis profile-area under the curve (PAP-AUC).The minimal inhibitory concentrations(MICs) of vancomycin,teicoplanin and linezolid were determined by microbroth dilution as recommended by Clinical Laboratory Standards Institute(CLSI).The contribution difference between hVISA and vancomycin susceptible Staphylococcus aureus (VSSA) in different MIC range was compared.A retrospective case-control study of the patients with hVISA infection or VSSA infection was carried out and statistical analysis was performed using t test,Mann-Whitney test,x2 test and Fisher exact test.Results A total of 105 isolates of hVISA were screened by BHIA5T and BHIA6V (23.0％) with other 23 isolates by MET(5.0％) and 21 by PAP-AUC(4.6％).All isolates were 100％ sensitive to vancomycin,teicoplanin and linezolid.The vancomycin MIC [(1.76 ±-0.16) mg/L] in hVISA group was significantly higher than that in VSSA group[(1.09 ± 0.07)mg/L,P ＜ 0.01],which was a potential risk factor for hVISA infection.The retrospective study showed chronic obstructive pulmonary disease (COPD) was also a risk factor for hVISA infection of the lower respiratory tract.No significant difference in infection attributable mortality was showed between the hVISA group and the VSSA group.Conclusions The overall prevalence of hVISA in Zhongshan Hospital is estimated as 4.6％,while the prevalence of hVISA isolated from blood is as high as 12.5％.All isolates are 100％ sensitive to vancomycin and linezolid.COPD is a risk factor for hVISA infection of the lower respiratory tract.

Objective:To investigate the predicting value of European system for cardiac operative risk evaluation ( EuroSCORE ) and sino system for coronary operative risk evaluation ( SinoSCORE ) in early quality of life of patients after coronary artery bypass surgery (CABG).Methods:A total of 218 consecu-tive patients who underwent CABG from March 2010 to January 2013 were evaluated with both systems before operation .Health related quality of life ( QoL) was estimated by using 36-item short form health survey ( SF-36) preoperatively and postoperatively in order to evaluate the predicting value of the two sys -tems in early post-operative QoL.Calibration was evaluated by Hosmer-l,emeshow goodness-of-fit test. Discrimination was tested by determining the area under the receiver operating characteristic ( ROC ) curve .Results:There was no significant difference between the accumulation of the EuroSCORE and SinoSCORE in the all patients (t=-0.904, P=0.368), When using Wilcoxon test on life quality in the preoperative and postoperative patients respectively ,the data showed that the quality of life improved significantly in various dimensions of the postoperative patients (Z=-2.886, P<0.001).Except for bodily pain (BP) and mental health (MH), statistically significant correlation was found between the preoperative risk evaluation scores and the postoperative QoL scores (r:-0.203 to -0.493, P<0.05). Logistic regression analyses indicated that both the scores emerged as the independent predictor for a relatively worse QoL ( OR>1 , P<0 .05 ) .Furthermore , the EuroSCORE predicted the outcome with a higher OR.For SinoSCORE the Hosmer-Lemeshow test was significant (P=0.628) and the area under ROC curve was 0.754.For the EuroSCORE the Hosmer-Lemeshow test was significant (P=0.538) and the area under ROC curve was 0.854.Conclusion:Both EuroSCORE and SinoSCORE could be viewed as a predictor for several aspects of postoperative QoL , while EuroSCORE might have a greater predicting value.

Objective To evaluate the long-term efficacy of using penile skin flaps for urethroplasty in the treatment of anterior urethral strictures.Methods Between Jan 2006 and Dec 2012,138 patients with anterior urethral stricture were treated by using penile skin flaps for urethroplasty.The mean age was 38 years (range,7-82 year).The etiology of stricture included trauma in 78 cases,iatrogenicity in 41 cases,infection in 17 cases,unknown reason in 2 cases.The penile urethral stricture was found in 110 cases and the bulbourethral stricture was found in 28 cases.The mean length of anterior urethral stricture was 6.5 cm (range 3-14 cm).Among them,the length of urethral stricture was more than 10 cm in 48 patients.Basing on location,length of stricture and condition of penile skin,different penile skin flaps were chosen,including vertical pedicle skin flap,pedicle circular flap,L-flap,Q-flap.Three different techniques were used for urethroplasty,such as lateral patch flap urethroplasty (group1,n=80),dorsal and ventral inlaid flap urethroplasty (group 2,n =42) and tubularized flap urethroplasty (group 3,n =16).Results 4 patients were lost during follow-up.The mean duration of follow-up in the remaining 134 patients was 39 months (range,8-84 months).Complications developed in 29 of 134 patients (21.6％),including strictures recurrence in 17 (group 1,n =12,group 2,n=2 and group 3,n =3),urethrocutaneous fistulas in 7 (group 1,n =5,group 2,n=1 and group 3,n =1) and urethral diverticulum in 5 (group1,n =4,and group 3,n =1).105 cases voided well and the urinary peak flows ranged from 13-49 ml/s (mean 25 ml/s),The overall success rate was 78.4％ (105/134).Conclusions Penile skin is thinner,rich in blood supply and easy to be manipulated,which is one of the excellent materials for the urethral reconstruction.Q-flap or L-flap urethroplasty is an effective technique for the treatment of long-segment urethral strictrues (≥ 10 cm).