Objective To investigate the safety and feasibility of carotid artery stenting (CAS) and evaluate its clinical outcomes. Methods From July 1998 to December 2003, 30 consecutive patients with 32 lesions underwent extracranial CAS procedures. Thirteen patients had a history of stroke or TIAs, 22 were hypertensive, 11 were diabetic and 8 had history of MI. Neurological assessment, Carotid duplex ultrasound, carotid and intracranial angiography were done before CAS in all patients. All the cases were done percutanously from femoral arteries and stenting was applied in all procedures. Carotid duplex ultrasound, cardiac and neurological elevation were performed post procedure. Results 30 patients (26 male and 4 female) underwent a total of 32 CAS procedures. Total 32 self-expandable stents and 1 tubular stent were implanted in all the cases. Direct stenting technique was applied in 9 cases. The other 21 procedures were performed with distal filtration supporting devices. The device can not be delivered due to tortuous target vessel in one case (success rate 95%) and CAS success rate was 97%. The particles were found in all filter baskets. Four patients underwent coronary artery bypass grafting 1 month later post CAS without perioperative neurological and cardiac events. One patient had contralateral cerebral hemorrhage during CAS and died three days later. Another patient died three days after CAS due to acute pulmonary edema. No restenosis was found by means of carotid duplex ultrasound during the follow-up (3-60 months) study. Conclusion CAS is safe and feasible in preventing ischemic stroke. This new alternative has satisfied clinical outcomes in managing cardiac and neurological ischemic diseases. Operative embolic complication can be potentially prevented by neurological protective device.

Objective To evaluate the forecasting value of renal scintigraphy (ECT) on the diagnosis of renovascular hypertension (RVH). Methods Twenty-four cases of coronary heart disease and hypertension were selected. All of them were suspected of RVH. They underwent ECT and renal arterial angiography (RAA). Results The 24 cases were diagnosed as RVH. The diagnostic sensitivity of renal scintigraphy in RVH was 83.3% (P

Objective To study cyclooxygenase-2 (COX-2) expression levels in cervical, endometrial and ovarian cancers as well as their originated normal tissues. Methods Semiquantitative immunofluorescent assay (IFA) was used to detect COX-2 expression levels in cervical squamous cell carcinoma (n=12),endometrial adenocarcinoma (n=13),and ovarian serous adenocarcinoma (n=9). COX-2 expression levels in normal cervical (n=14),endometrial (n=15),and ovarian (n=13) tissues were simultaneously detected as control. Results Normal cervical tissues expressed COX-2 more frequently than cervical cancers (50% vs 23%), but the difference was not signicant (P=0.247). The positive rate of COX-2 expression was significantly higher in endometrial adenocarcinomas (69%) than that in normal endometrium (7%) (P

Objective To assess the role of matrix metalloproteinase-9(MMP-9) and interleukin-6 (IL-6) of amniotic fluid (AF) in predicting infection of amniotic cavity. Methods Eighty-four cases of sigle foetus women with premature delivery, premature rupture of foetal membranes,or suspicious infection of amnitotic cavity were enrolled in this study. AF was obtained by transabdominal amniocentesis before starting any treatment.Infection of amniotic cavity was defined when AF bacterial culture was positive. The contents of glucose, leukocytes, MMP-9,and IF-6 in AF were determined. Results The levels of MMP-9 and IL-6 in AF were significantly higher in women with infection of amniotic cavity than those in women without. In women with infection of amniotic cavity, MMP-9 level was significantly correlated with IL-6 level (r=0.813,P

Objective To investigate the value of detecting hepatitis B virus (HBV) YMDD variants by matrix-assisted laser de-sorption time of flight mass spectrometry (MALDI-TOF MS). Methods The assay is based on polymerase chain reaction (PCR) amplifica-tion and mass measurement of oligonucleotides containing sites of mutation of the YMDD motif. Result The MALDI-TOF MS-based genoty-ping assay was sufficiently sensitive to detect as few as 100 copies of HBV genome per milliliter of serum, and this method had superior spe-cificity for determining mixtures of wild-type and variant viruses. When sera of 40 patients were analyzed, the MALDI-TOF MS-based assay correctly identified known viral variants and additional viral quasi-species not detected by previous methods, as well as their'relative abun-dance. Conclusion The sensitivity, specificity and amenability to high-throughput analysis make MALDI-TOF MS-based assay suitable for mass screening of HBV infected patients who are receiving lamivudine.

Objective To evaluate the causes and prognosis of severe trauma in the elderly.Methods The 168 patients in elderly group (aged 60 to 91 years), 517 in middle-aged group (aged 36to 59 years) and 405 in young group (aged 18 to 35 years) were evaluated using an abbreviated injury scale (AIS2005) and injury severity score (ISS). All patients with ISS ≥ 16 were selected during a seven-year period. The injury severity, injury site number, cause of injury, injury site, emergency operation, diseases before injury, secondary infection after injury, development of multiple organ dysfunction, number of patients with Intensive Care Unit (ICU) stay, length of stay in ICU and prognosis were compared among three groups. Results The main cause of injury was accident (64patients, 38.1%), followed by traffic accident (63 patients, 37.5%) in elderly group. The traffic accident was major cause of injury in middle-aged and young group (246 patients, 47.6%; 153patients, 37.8%, respectively), followed by fall from high places (128 patients, 24.8%; 102 patients, 25.2%, respectively). The main injury sites were head and chest in elderly, middle-aged and young group (155 patients, 92.3%; 411 patients, 79.5%; 321 patients, 79.3%, respectively).There were significant differences among three groups in injury site number, emergency operation,pre-injury diseases, secondary infection after injury, number of patients with ICU stay and length of stay in ICU (F=8. 299, P＜0.01; x2= 14.88, P=0.001; x2=254.6, P＜0.01; x2=10. 54, P=0. 005; x2 = 15.62, P＜0.01; F= 5.760, P= 0.005, respectively ). In spite of injury severity (F=2.950, P= 0.053), there were significant differences between elderly group and middle-aged or young group (t=2.325, P=0.021; t=2.128, P=0.034, respectively). The incidence of multiple organ dysfunction had no significant difference among the three groups (x2 = 1.142, P= 0.565). The cure rate and unhealed automatically discharged patients had significant differences (x2 = 13.77, P= 0. 001;x2 =6.025, P= 0.049, respectively). The mortalities were similar (x2 = 1.397, P= 0.497). The leading cause of death among three groups was a serious head injury. Conclusions For elderly patients, it is important to reduce accidental injuries and traffic accidents, to improve the cure rate,and to reduce the unhealed and mortality rate.

Objective To assess the clinical features and risk factors of coronary heart disease(CHD)in patients with systemic lupus erythematosus (SLE).Methods The clinical data of 32 lupus patients with CHD and 64 age and sex-matched lupus patients without CHD from a total of 1792 in-patients with lupus from January 1994 to December 2008 were collected and retrospectively analyzed.The traditional risk factors of atherosclemsis as well as their association with the characteristics of lupus were evaluated and compared between the two group of patients.Results The average age of CHD group was(51±12)years with an average disease duration of((8±6) years、.The most common coronary events were acute myocardial infaretio(53%)and non-stable,angina[34%).Among the 12 patients who accepted coronary angiography or computed tomography scan of coronary artery,11 patients had significant atheroselerosis lesions and 1 had thrombosis in coronary arteries.Their atheroselerosis lesions were severe,which manifested as diffuse stenosis and severe calcification.Compared to the control group,the CHD group patients had more traditional risk factors[(3.9±1.8)vs(2.0±1.6),P<0.01 j as well as higher prevalence of hypertension,hyperlipidemia,postmenopausal and smoking(P<0.05).Meanwhile,the CHD group patients had longer SLE duration[12.0(6.3~19.8)vs 2.0[O.8～9.0)years,P<0.01)J,higher C3 level[(750±364)vs(598±267)mg/L,P<0.05]and higher totalprednisone dose[28.8(0~49.8)vs 24.0(0~24.6)g,P<0.05]compared to patients without CHD.No significant differences were found in auto-antibodies,SLE disease activity,organ damage,average Drednisone dose and cyclophosI,hamide usage between the two groups of patients.Multi-variate analysls showed more traditional risk factors(OR:1.62)and longer SLE duration(OR=1.09)Were independent predictors of CHD.Condusion Atherosclerosis is a common pathological change of coronary in lupus patients with CHD.Traditional risk flactors of atherosclerosis and lupus duration are identified to be the independent risk factors of CHD in SLE patients.Early interventions for traditional risk factors and appropriate control of lupus arerecommended.

Objective To evaluate the imaging feature of microcarcinoma of thyroid with CT.Methods CT findings of 50 lesions in 47 patients with microcarcinoma of thyroid ( dimeter,0.5 to 1.0 cm) were retrospectively analyzed.All of the patients had pathological diagnosis.Results Of the 50 lesions,38 lesions showed homogeneous low density on non-enhanced CT and various degree of enhancement on postcontrast CT. Thirty-three lesions showed discontinuous edge of the thyroids on non-enhanced CT. The boundary of 30 lesions became unclear on post-contrast CT relative to non-enhanced CT and the extension of low density of lesions decreased. Theshape of 31 lesions were irregular. Fifteen lesions showed calcifications,with granular calcifications in 13 lesions.Ten lesions were complicated with thyroiditis.Conclusions Irregular shape,discontinuous edge of the thyroids,the shrinkage of low density of lesions on post-contrast CT relative to non-enhanced CT,granular calcifications and multiple small lymph node around lesions indicate the diagnosis of microcarcinoma of the thyroid.It should be noted that thyroiditis can cover up microcarcinoma of thyroid.

Forty two resident general practitioners (GPs) attending obstetrics and gynecology course in Beijing Hospital were divided into trial group and control group with 21 in each group. The 2-hour study content uterine fibroids was taught by the same teacher. For control group the traditional classroom teaching mode was used, while for the trial group the WeChat-based flipped classroom model was used. The teaching effectiveness was evaluated by means of paper examination, critical examination and questionnaire survey. The average scores and the clinical reasoning scores of trial were significantly higher than those of control group [(90.5±3.4) vs. (82.5±4.2) points and (94.5±1.5) vs. (84.5±2.0) points; t=4.28, P<0.05 and t=5.01, P<0.05, respectively]. Compared with the control group, the trial group presented more learning interest, higher learning efficiency and self-learning ability; and also the ability of expression and communication was improved, the ability of teamwork and the ability of analyzing and solving problems was enhanced more markedly in trial group (all P<0.05). The result indicates that WeChat-based flipped classroom teaching model can improve the learning efficiency in general practice residency training.

Objective To explore the secretion of chemokine regulated upon activation normal T cell expressed and secreted(RANTES)influenced by the complex microenvironment in the peritoneal cavity of women with endometriosis and investigate chemotaxis of RANTES on the peritoneal monocytes.Methods The contact and non-contact co-culture systems including three target cells of ectopic tissue were established.The three target cells were endometrial stromal cells(ESC),human peritoneal mesothelial cells(HPMC)and monocytes.After collection of the supernatant of co-culture systems,the levels of RANTES were detected by enzyme linked immunosorbent assay(EUSA).Migration of U937 cell,a monocyte line,was detected by chemotaxis assay.Results ESC,HPMC,and U937 cultured alone secreted slight RANTES,(5.0±0.5),(4.0±0.3),and (254±40)ng/L. Compared with the culture of the target cell alone,the levels of RANTES in each co-culture system increased significantly,with the highest level in the contact culture system of E-H-U(2250±96)ng/L. RANTES secretion of non-contact co-culture of three cells were higher than contact co-culture of two cells(P＜0.01):U/E-H(912±93) vs E-H(50±40)ng/L,H/E-U(1201±93) vs E-U(243±192)ng/L,and E/H-U(1519±96) vs H-U(1251±73)ng/L. ESC,HPMC,and ESC-HPMC co-culture improved significantly migration of U937 cells [ number of cell migration respectively(6.0±0.3),(6.2±0.3),(10.0±0.3)×103,P＜0.01],which could be inhibited efficiently by anti-RANTES neutralizing antibody.Condusion The target cells in the peritoneal cavity of patients with endometriosis promote the secretion of RANTES in autocrine and paracrine manners and migration of monocytes.