Objective To investigate the positive rate of microembolic signal (MES) and the related factors,as well as the correlation between MES and outcomes in patients with cardiogenic cerebral embolism.Methods Patients with cardiogenic cerebral embolism were enrolled.The baseline data of the patients were collected and the MES monitor was conducted.The baseline data of the MES positive group and MES negative group were compared.Multivariatelogistic regression analysis was used to identify the related factors of the positive MES.The patients were followed up regularly.The outcomes of stroke at 6 months and recurrent stroke within 2 years in the MES positive group and MES negative group were compared.Results A total of 165 patients with cardiogenic cerebral embolism were enrolled,including positive MES in 68 patients (41.2％).There were significant difference in the levels of brain natriuretic peptide (BNP),cardiac troponin-I (cTn-I),and D-dimer between the MES positive group and negative group.Multivariate logistic regression analysis showed that the increased levels of baseline BNP (odds ratio [OR] 1.001,95％ confidence interval CI 1.001-1.002;P＜0.001),cTn-I (OR 36.975,95％ CI 1.516-902.0;P=0.027),and D-dimer (OR 1.001,95％ CI 1.000-1.001;P=0.017) were independently associated with the positive MES in cerebral embolism within 48 h after onset.There was no significant difference in the proportion of patients in good outcome (modified Rankin scale score 0-2) and poor outcome (modified Rankin scale score ＞2) after 6 months between the MES positive group and MES negative group.When the average follow-up time was 20.8 months (range,7-24 months),there were 23 patients (33.8％) and 19 (19.6％) had recurrence in the MES positive group and MES negative group,respectively.Kaplan-Meier analysis showed that the recurrence rate of stroke in the MES positive group was significantly higher than that in the MES negative group (log-rank test:P=0.031).COX regression analysis showed that the positive MES was still an independent risk factor for stroke recurrence after adjusting for other confounding factors (OR 0.328,95％ CI 0.142-0.761;P=0.009).Conclusions The positive MES was associated with the increased BNP,cTn-I,and D-dimer levds.The positive MES was not associated with clinical outcomes at 6 month after the onset,but it was associated with the recurrence of stroke within 2 years.

Objective To explore the incidence and possible risk factors of restless legs syndrome (RLS) in the maintenance hemodialysis patients.Methods A total of 375 maintenance hemodialysis patients were enrolled in this study from September 1 to 30 in 2012.The diagnosis and assessment of severity were based on the International Restless Leg Syndrome Study Group (IRLSSG) standard.The relevant laboratory parameters and dialysis indicators were collected,such as hemoglobin,serum ferritin,parathyroid hormone,blood flow and dialysis mode.The clinical data were analyzed by multivariate logistic regression method.Results The incidence of RLS was 13.3％ with the severity score of 18.69 ± 0.95.The logistic regression analysis showed that anuria (OR 0.292,95％ CI 0.114-0.750) and β2 microglobulin(OR 1.023,95％C1 1.003-1.044) were the risk factors for RLS in the maintenance hemodialysis patients,while hemoglobin,serum iron and parathyroid hormone were not correlated with RLS.Conclusions The incidence of RLS is high in the maintenance hemodialysis patients.The risk factors of RLS are anuria and β2 microglobulin.Therefore,the preservation of residual renal function and the improvement of dialysis adequacy,especially the removal of the middle molecular weight toxins,may reduce the occurrence of RLS and improve the quality of life in the hemodialysis patients.

This article was to elucidate that the needling depth is closely related to the meridian qi, disease location, disease nature and needled area based on the records of needling depth in Nei Jing (Canon of Internal Medicine). Moreover, different depths will produce different therapeutic efficacies;meanwhile, improper depth may lead to grave consequences.

Objective To evaluate the detection of membrane neutrophil alkaline phosphatase (NAP)in diagnosis of infection in patients with acute cerebral hemorrhage.Methods A total of 208 patients with acute cerebral hemorrhage,including 1 52 cases without infection (uninfected group)and 56 cases with infection (infected group),admitted in the Second Affiliated Hospital of Nantong University during January 201 0 to July 201 6 were enrolled,30 healthy subjects were also enrolled in the study as control group.The peripheral blood from all subjects were collected,and the counts of white blood cell (WBC), percentage of neutrophil,serum procalcitonin (PCT)and NAP were measured.The value of above 4 indicators in diagnosing infection was determined by receiver operating characteristic (ROC ) curves. ANOVA and t test were used to analyze the data,Pearson correlation was performed to analyze the correlation between NAP and PCT in infected group.Results The levels of WBC,percentage of neutrophil and NAP in both infected and uninfected group were higher than those in healthy control group at admission(F =1 1 7.64, 1 00.69 and 425.09,all P <0.01 ),and the levels of WBC,PCT and NAP were also higher when infection occurred compared with those at admission in infected group (t =3.1 4,34.30 and 36.39,all P <0.01 ). The expression of NAP was positively correlated with PCT in infected group (r =0.762,P <0.05).ROC curve analysis showed that the areas under the curves of NAP and PCT in diagnosis of infection were 0.875 and 0.884,respectively.When 1 0655.28 AB/c and 5.01 mg/L were taken as cut-off values,the sensitivities of NAP and PCT in diagnosis of infection were 85.50% and 87.66%;the specificities were 90.50%和 90.31 %,respectively.The level of NAP in infected patients with gram-positive bacterial infections was higher than that in patients with gram-negative bacterial infections (t =6.29,P <0.01 ). Conclusion The expression of NAP in patients with acute cerebral hemorrhage increases when infection occurs,which may be helpful to the clinical diagnosis of bacterial infection.

Objective To research the social economic development and service needs of families with more than one disabled in Henan, China. Methods The data of 2016 Basic Service Status and Needs of People with Disabilities in Henan was analyzed. Results A to-tal of 74,732 (4.0%) people with disabilities from all 19 cities in Henan had been surveyed, 54.9%were males and 83.2%were from rural ar-eas. In terms of social and economic development, 41.8%of people with disabilities in urban areas were below least living baseline, 14.7%met standards of low income;23.9%of people with disabilities in rural areas were recorded as national poverty household, 35.7%were not recorded as national poverty household, 39.9%were not in poverty. In terms of housing, 75.3%of people with disabilities in urban areas had their own houses, 7.1%had housing security welfare, 12.9%had no house; 70.5%of people with disabilities in rural areas had their own houses in good condition, 3.5%had their own houses which were identified as houses in risk, 15.9%had their own houses which were sus-pected to be houses in risk, 1.7%had no house, and 2.2%had their own houses reconstruction. There were significant differences in the eco-nomic and housing conditions among different types of disabilities (χ2>51.267, P<0.001), and in people under standards of low income and others among different levels of disabilities (χ2>8.400, P<0.05). For people with disabilities in rural areas, there were significant differences in the economic and housing conditions among different types of disabilities (χ2>70.149, P<0.001), and no significant difference was found among different levels of disabilities (χ2<6.446, P>0.05). In terms of employment needs, vocational skills training 5.0%, introducing a job 3.9%, practical training in rural areas 6.6%, capital credit support 7.6%, and others 10.7%. There were significant differences in the employ-ment needs among different types of disabilities (χ2>73.180, P<0.001), and in the needs of vocational skills training, introducing a job, practi-cal training in rural areas and capital credit support among different levels of disabilities (χ2>11.440, P<0.01). In terms of caring service needs, home caring 54.1%, day care 11.1%, and institutional residential care 2.9%. There were significant differences in caring service needs both among different types and levels of disabilities (χ2>38.960, P<0.001). In terms of rehabilitation needs, surgery 2.1%, medicine 22.5%, functioning training 16.1%, assistive devices 29.8%, and nursing 14.8%. There were significant differences in rehabilitation needs among different types of disabilities (χ2>99.220, P<0.001), and in needs of nursing among different levels of disabilities (χ2=12.465, P<0.01). In terms of barrier-free reconstruction, sloping and handrail 17.7%, door 14.2%, bathroom 30.3%, kitchen 20.5%, visual doorbell with flash 3.4%, gas leak alarm device 2.3%, and internet access and screen software 0.6%. There were significant differences in barrier-free recon-struction among different types of disabilities (χ2>68.000, P<0.001) except visual doorbell with flash, gas leak alarm device and internet ac-cess and screen software. There was significant difference in needs of flash and visual doorbell, gas leak alarm device and internet access screen software among different levels of disabilities (χ2>46.960, P<0.001). Conclusion The social economic development of families with more than one disabled were faced risk. Recommendation to policy development included to improve the support efforts, and ensure their ba-sic housing, pay attention to their individual differences in employment poverty alleviation needs and provide more opportunities to get jobs, and provide financial support, increase support for home care, increase inputs of funding and assistive devices for rehabilitation services, and attach importance to their needs of barrier-free reconstruction.

0bjective To determine the optimal contrast protocols for 64.slice spiral CT coronary angiography in order to reduce the volume of contrast injection.Methods One hundred fifty pailents scheduled to undergo 64-slice spiral CT coronary angiography were prospectively randomized into the following five groups with different injection protocols:group l:uniphasic injection without a flush;group 2:biphasic injection with a flush;group 3,group 4 and group 5:triphasic injection with a diluted contrast material with 3:7.5:5.7:3 contrast/saline ratio respectively.Attenuation was measured in the right atrium,right ventricle,left atrium,left ventricle,ascending aorta,fight coronary artery and left coronary artery and analyzed with single factor variance test(ANOVA).The quality the coronary artery images was evaluated and compared using person Chi-Square.Results The total contrast material vohme were (67.0±5.3)ml,(59.9±4.9)ml,(62.9±3.2)ml,(69.2 4±5.7)ml and(70.9 4-4.6)ml in five groups respectively(F=27.43,P<0.01).Image quali～scores of coronary arteries were significant different among five groups(X2=18.81,P<0.05).There were signiflcandy differences in artifacts of the superior vena cava among five groups(X2=31.44,P<0.01).The artifacts in the superior vena cava in group 1 was the most,and in group 2 was the least.The mean enhancement values of right and left coronary arteries in group 2 were significantly greater than those in other groups(F=2.47 and 4.10,P<0.05).The visualization of both left ventricle and right ventricle cavities W88 the best in group 3.Conclusion Biphasic injection and triphasic injection are better than uniphasic injection for 64-slice spiral CT coronary angiography and triphasic injecfion is better than biphasic injection for the visualization of both left ventricle and right ventricle cavities.

OBJECTIVETo investigate the impact of pre-operative uric acid on acute kidney injury (AKI) after cardiac surgery in elderly patients.

METHODSClinical data were collected from 936 elderly patients (age ≥ 60 years) undergoing cardiac surgery with cardiopulmonary bypass in Guangdong General Hospital between January 2005 and May 2011. The baseline serum creatinine was defined as the latest serum creatinine before surgery, and AKI was diagnosed according to RIFLE criteria. Patients were divided into three groups according to the sex-specific cutoff values of serum uric acid tertiles (group A: ≤ 384.65 µmol/L in men, and ≤ 354.00 µmol/L in women; group B:384.66-476.99 µmol/L in men and 354.01-437.96 µmol/L in women; group C: ≥ 477.00 µmol/L in men and ≥ 437.97 µmol/L in women). Multivariate logistic regression analysis was used to analyze the independent risk factors for AKI.

RESULTSAmong 936 elderly patients, 576 cases (61.5%) developed AKI. Mean uric acid concentration was higher in AKI patients than in Non-AKI patients ( (436.6 ± 119.1) µmol/L vs. (398.0 ± 107.2) µmol/L, P < 0.001). The incidence of AKI was 56.1% (175/312) in group A, 56.3% (175/311) in group B, 72.2% (226/313) in group C (P < 0.001). Multiple logistic regression analysis showed that, after adjusted for age, gender, co-morbidities(hypertension, diabetes mellitus, cerebrovascular disease, chronic obstructive pulmonary disease), previous cardiac surgery, eGFR<60 ml×min(-1) ×1.73 m(-2), heart function ≥ 3 (NYHA), positive urine protein, combination of coronary artery bypass grafting and valvular surgery, cardiopulmonary bypass operation time, aortic cross-clamping time, pre-operative angiotensin converting enzyme inhibitor or angiotensin II receptor blockers and lipid-lowering drugs use, early postoperative angiotensin converting enzyme inhibitor or angiotensin II receptor blockers, diuretics and digoxin use, post-operation central venous pressure, risk of post operative AKI was significantly higher in group C than in group A (OR:1.897, 95%CI: 1.270-2.833, P = 0.002).

CONCLUSIONPre-operative elevated uric acid is an independent risk factor of AKI after cardiac surgery in elderly patients.

Acute Kidney Injury ; etiology ; Aged ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Cardiac Surgical Procedures ; adverse effects ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Female ; Humans ; Incidence ; Kidney Function Tests ; Male ; Middle Aged ; Predictive Value of Tests ; Risk Factors ; Uric Acid ; blood

Objective To analyze the image quality of coronary arteries by dual-source computed tomography (DSCT) in children with congenital heart disease(CHD). Methods Image quality of coronary arteries were scored by two radiologists with an ordinal grading system. Score 3 or 4 was considered to be good image quality and diagnostic. Score differences among 3 groups of various baseline heart rate levels, 3 groups of various age levels and 4 coronary branches were analyzed by using ANOVA. Multiple linear regression analysis was used to test the effects of age, heart rate, tube voltage, tube current, pitch, contrast volume, contrast injection rate on the coronary image scores. Results A total of 72 consecutive patients were enrolled. 71.2% (205/288) of coronary artery branches was good enough for diagnosis. Image quality of left main coronary artery (LM, score 3.64±0.49), left anterior descending (LAD, score 2.97±0.40), right coronary artery (RCA, score of 2.82±0.70), left circumflex (LCX, score 2.76±0.73) were in a descending order (F=29.00, P<0.01). Image scores of age groups of 0--1 years old (2.80±0.65), >1--3 years old (2.81±0.74), >3--14 years old (3.58±0.52) were in an ascending order (F= 20.16,P<0.01). Image scores of heart rate groups of<100 bpm (3.54±0.56),100--150 bpm (2.86± 0.70) and >150 bpm (2.81±0.63) were in a descending order (F=16.72, P<0.01). Multiple linearregression analysis demonstrated that multiple impact factors affected image quality of LM, LAD, LCX and RCA. Age(r=0.013 ,P<0.01)and contrast volume(r=0.292, P<0.01)had positive correlation with LM score. Age(r=0.509, P<0.01) and voltage (r=0.292, P=0.011) had positive correlation with LAD score. Heart rate(r= -0.179, P<0.05) had negative correlation with LAD score. Age (r=0.063, P< 0.01) had negative correlation with LCX score. Age (r=0.486,P<0.01) and voltage (r=0.220, P<0.05) had positive correlation with RCA score. Conclusions Dual-source CT could clearly shows coronary arteries of children with CHD over the age of 3 or with heart rate less than 100 bpm. Limitations of Dual-source CT coronary angiography for CHD children included young age and fast heart rate.

Objective To characterize the cardiac magnetic resonance (CMR) features of peripartum cardiomyopathy(PPCM) and idiopathic dilated cardiomyopathy(IDCM), and to explore the value of MRI in the diagnosis of PPCM. Methods Ten cases of PPCM and 10 cases of Idiopathic dilated cardiomyopathy (IDCM) were included in this study. With 1.5 T MRI scanner, the heart shape (atrioventricular size, hypertrabeculation, thickness of the thinnest ventricular wall), function (ventricular wall movement and the overall function), cardiomyopathy perfusion were comprehensively evaluated. Paired samples t?test and Fisher exact probability method were used for statistical analysis. Results Between PPCM and IDCM group, there was no statistical significant difference in the atrioventricular size, cardiac output(CO), end diastolic volume(EDV), ejection fraction (EF), end systolic volume (ESV) and stroke volume (SV) (P>0.05). IDCM and PPCM group both showed ventricular wall thinning on MRI, with 4 cases of PPCM and 3 cases of IDCM presenting hypertrabeculation in the left ventricular apex. Seven cases of PPCM and 4 cases of IDCM depicted left ventricular local dysfunction, while 3 cases of PPCM and 6 cases of IDCM had abnormal integral movement. Two cases of PPCM appeared local delayed enhancement, while 4 cases of IDCM showed intramural delayed enhancement. After one year of follow?up, heart function recovered in 10 cases of PPCM and 4 cases of IDCM. Conclusions MRI diagnosis using multiple sequences is an ideal method in the evaluation of PPCM. Although there were no differences in cardiac morphology and function between PPCM and IDCM, the prognosis of PPCM is better than IDCM.

ObjectiveTo assess the value of free-breathing 3D phase sensitive inversion recovery (PSIR) turbo FLASH for demonstrating the left ventricular myocardial scar in patients with myocardial infarction.MethodsTwenty-three patients with myocardial infarction underwent 2D and 3D phase sensitive inversion recovery (PSIR) Turbo FLASH sequences 10-15 minutes after injection of dimeglumine gadopentetate.The image quality,the area,location and volume of hyperenhanced scar were independently assessed by two experienced radiologists.Student′s t test or rank sum test and Pearson linear correlation were used for the statistics.ResultsThere were no significant differences in the overall image quality (2.57 ±0.59 vs 2.39 ±0.66,Z=-0.93,P =0.35),the area (24.48 ±10.83 vs 29.00 ± 11.56,Z=-1.41,P =0.16) and location ( 16.78 ± 6.51 vs 18.87 ± 6.76,Z =- 1.17,P =0.24) of hyperenhanced scar between 2D and 3D PSIR sequences.The mean volume of hyperenhanced scar was significantly greater in 3D PSIR sequence than that in 2D PSI R sequence [(23.46 ± 10.61 ) vs (31.65 ±　 13.86) cm3,t =-2.25,P =0.03].There was a good correlation in the volume of hyperenhanced scar between 2D PSIR and 3D PSIR sequences (r=0.940,P＜0.01 ;y =2.851 + 1.228x,R2 =0.883).ConclusionFree-breathing 3D PSIR Turbo FLASH is a promising new imaging technique for accurate assessment of myocardial scar.