Objective To investigate the different characteristics of vertebral basilar artery between isolated vertigo and dizziness with ischemic stroke history by magnetic resonance angiography (MRA) information,and find the independent risk factors of isolated vertigo.Methods From January 2015 to January 2016,isolated vertigo patients from our department were enrolled in study group (vertigo group),and dizzy patients with ischemic stroke history in control group (dizziness group).The patient's general information,and the relevant vascula data of the MRA were statistically analyzed to find the risk factors.Results A total of 118 patients with isolated vertigo was enrolled in the vertigo group,and 74 patients with dizziness after ischemic stroke were used as a control group.There were significant statistical differences in mean diameter of the right vertebral artery,rate of stenosis of basilar artery,vertigo history,the left vertebral artery hypoplasia,basilar artery skewing,and basilar artery hypoplasia between two groups (P ＜ 0.05).Multivariate logistic regression analysis showed that vertigo history (P =0.049,OR =3.822,95％ CI =1.004 ～ 14.548),the right vertebral artery hypoplasia (P =0.001,OR =6.083,95％ C1 =2.193 ～ 16.876),the left vertebral artery hypoplasia (P =0.006,OR =5.110,95 ％ CI =1.615 ～ 16.170),and mean diameter of the right vertebral artery (P =O.000,OR =3.143,95％ CI =1.724 ～ 5.730) were independent risk factors for isolated vertigo,and basilar artery skewing (P =0.018,OR =O.436,95％ CI =0.219 ～ O.866),and degree of basilar artery stenosis (P =0.006,0R =0.634,95％ CI =0.459 ～0.877) were the protective factors.Conclusions The right vertebral artery hypoplasia,the left vertebral artery hypoplasia,and mean diameter of the right vertebral artery are independent risk factors for isolated vertigo.Basilar artery skewing and degree of basilar artery stenosis may be the protective factors.

Objective To investigate the correlation between the morphological characteristics of vertebrobasilar artery on magnetic resonance angiography (MRA) and isolated vertigo. Methods The patients with isolated vertigo were enrolled retrospectively as a case group. Other patients without vertigo were selected over the same period as a control group. The clinical data and MRA data were collected. Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors for isolated vertigo. Results A total of 118 patients with isolated vertigo and 179 controls were enrolled. Univariate analysis showed that there were significant differences in left vertebral artery bending degree, basilar artery stenosis rate, previous stroke, dolichoec tatic basilar artery, and left and right vertebral artery hypoplasia between the two groups (all P < 0.05). Multivariate logistic regression analysis showed that previous vertigo (odds ratio [OR] 6.177, 95%confidence interval [CI] 1.945-19.620; P = 0.002), more serious left vertebral artery bending (OR 1.860, 95% CI 1.127-3.069; P =0.015), and left vertebral artery hypoplasia (OR 4.543,95% CI 1.761-11.721; P = 0.002) were the independent risk factors for isolated vertigo, and previous stroke ( OR 0.377, 95% CI 0.162-0.877; P = 0.024), basal artery hypoplasia ( OR 0.401, 95% CI 0.193-0.830; P = 0.014) were its protective factors. Conclusions Previous vertigo, more serious left vertebral artery bending, and left vertebral artery hypoplasia are the independent risk factors for isolated vertigo, and previous stroke and basal artery hypoplasia may be its protective factors.

BACKGROUND: Vasorelaxation plays an important role In the occurrence of cyclosporine A (CsA)-induced nephrotoxlcity.OBJECTIVE: To observe the alleviative effects of green tea polyphenols (GTP) on CsA-induced inhibition of vasorelaxation and the underlying mechanisms.METHODS: Sprague-Dawley rats were randomly and evenly divided into four groups: CsA, control, CsA + GTP, and GTP. After 5 weeks of drug treatment, blood urea nitrogen (BUN) and creatinine (Cre) levels were determined. Then the thoracic aorta rings were mounted on a bath system, and acetylcholine was used to induce vasorelaxation. The effects of L-NAME and indomethacin and the denuded vasorelaxation were evaluated.RESULTS AND CONCLUSION: The BUN and Cre levels in the CsA group were significantly higher than those in the control group (P < 0.05). The maximal response (Emax%) for acetylcholine-induced vasorelaxation in the CsA group was significantly lower than that in the control and GTP groups. After pretreatment with L-NAME, vasorelaxation was significantly lower in the CsA,CsA+GTP and GTP groups than in the control group. After pretreatment with indomethacin, vasorelaxation was significantly higher in the control, CsA +GTP, and GTP groups than in the CsA group. The level of nitric oxide metabolites in the vascular tissue in the CsA group was significantly lower compared with other groups. The results demonstrated that CsA can decrease nitric oxide levels in vascular tissues and induce abnormal endothelium-dependent vasorelaxation, which is mediated by nitric oxide pathway.

Cancer pain is the most important factor affecting the cancer patients' quality of life, and the approach to relieve and control cancer pain is becoming the focus. Pain mechanism research can offer solutions to pain treatment, such as blocking the happening and conduction of analgesia. The earliest μ, κ, σopioid receptors were found in the research of morphine and opioid peptides, especially μ receptor's leading role in pain treatment. Currently, μ opioid agonist is basically used in clinical pain treatment. Morphine, the third level drug, is still the classic pain therapy drugs. Novel drugs such as fentanyl transdermal and controlled-release oxycodone provide new ideas for the pain ease. Opioid combined with non-opioid drugs, the change of opioid drugs delivery way and joint application of controlled release drug and relievers, have dramatically reduced opioid drugs' side effects.

Objective To investigate the effect of angiotensin Ⅱ-1 receptor antagonist losartan on expression of tumor necrosis factor-alpha (TNF-?) in the ventricular myocardium in the renovascular hypertension rats. Methods Renovascular hypertension model was obtained by clip left renal artery in Sprague-Dawley(SD) rats. After operation the rats were divided into 3 groups: sham group, two-kidney one clip (2K1C) group, and losartan treatment group(2K1C and losartan 20 mg/kg?d by drinking). Tail blood pressure was determined every week. Animals were euthanized after treatment with losartan for four weeks. Cardiac index(CI)was calculated by HW/BW, and TNF-? protein of ventricle myocardium was determined by ELISA and immunohistochemistry. Results Losartan significantly decreased blood pressure(P

Objective To evaluate the effect of conversion from mycophenolat mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) on gastrointestine-related quality of life,as well as the safety and efficacy.Method A total of 41 renal transplant (RT) recipients were converted from MMF to EC-MPS (46.3 ± 17.1) months after the operation due to the gastrointestinal side effects of MMF,with a mean time of 46.3 months.Before the conversion and 12 weeks later,the patients were evaluated with Gastrointestinal Quality of Life Index (GIQLI) questionnaire,and the safety and efficacy were assessed.Result The average dose of MMF was 846.7 ± 291.3 mg/day before the conversion,with a mean dose of 639.5 ± 186.4 mg/day for EC-MPS.The total score of GIQLI was 103.6 ± 10.7 before the conversion,and 12 weeks after conversion 118.3 ± 15.1,with a statistical significance (P＜0.05).The safety of EC-MPS was excellent without infection,acute rejection episode,loss of allograft or death.The serum creatine was 136.9 ± 35.7 mol/L before conversion and 128.4± 40.8 mol/L after conversion (P ＞ 0.05).Conclusion For the RT patients with gastrointestinal side effects of MMF,conversion to EC-MPS could significantly alleviate gastrointestinal illness,and improve quality of life,with excellent safety and efficacy.

ObjectiveTo explore the efficacy and safety of percutaneous antegrade stenting in the treatment of ureteral obstruction after renal transplantation.MethodsWe retrospectively reviewed 11patients with renal graft ureteral obstruction (2 cases of acute obstruction and 9 cases of chronic obstruction) from March 2009 to March 2011.The etiology of the obstruction was renal graft-ureter-bladder anastomotic stricture in 5 cases,stone obstruction in 2 cases,and undetermined in 4 cases.Renal graft and collecting system were examined by ultrasonography preoperatively to select suitable puncture position,and then ureteropyelography was performed under X-ray guidance.When the obstruction location was clear,the urology guidewire was implanted to the bladder by needle,and then guidewire was released by cystoscopy.Ureteral stent was implanted along the guidewire,and upper ureteral stents was observed under X-ray. After removal of guidewire,the stent location was confirmed once again.The renal pelvis fistula drainage lasted for 1-2 weeks,and ureteral stent to 6 months to one year.Ultrasound and renal function were tested after 1week,1month,3 months and 6 months,and then every six months.ResultsOperation was done successfully in 10 patients,and failed in one case due to a long segment of ureteral stenosis.The operating time of ureteral stent implantation was 54±27 min.Serum creatinine of patients was reduced from preoperative 326±147 to postoperative 89±49 μmol/L.During a follow-up period of 6 to 27 months,no complications occurred.ConclusionPercutaneous antegrade stenting in the treatment of ureteral obstruction after renal transplantation is safe and effective.

BACKGROUND: Research has been reported that serum soluble CD146 (sCD146) expression was improved on the surface of endothelial cells and activated T cells by the stimulation of inflammatory factor. Therefore, it predicts that CD146 may participate in inflammatory reaction of tissue.OBJECTIVE: To investigate the expression and clinical significance of serum sCD146 in peripheral blood from patients with ankylosing spondylitis.METHODS: A total of 62 patients with ankylosing spondylitis were selected from the Sixth People's Hospital AffiUated to Shanghai Jiao Tong University. All patients were divided into two groups: active group (n=46) and inactive group (n=16); while, 20 healthy subjects were selected as the control group. Indicators including Bath Ankylosing SpondyUtis Disease ActivityIndex (BASDAI),Bath Ankylosing Spondylitis Functional Index (BASFI), patient's global assessment (PGA), night pain, visual analogue scale (VAS),morning stiffness time, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured in all patients. The serum concentration of sCD146 from 62 patients with ankylosing spondlitis and 20 healthy controls was measured by enzyme-linked immunosorbent assay. Westergren method was used to measure ESR and immunoturbidimetry for CRP. Clinical data of the patients were collected as well.RESULTS AND CONCLUSION: sCD146 levels of patients with ankylosing spondlitis were significantly higher than normal control group (P ＜ 0.05). The sCD146 expression in the active group was significantly higher than inactive and normal control groups (P ＜0.05). Positive correlations were observed between sCD146 and BASDAI index of patients with ankylosing spondlitis (P ＜ 0.05).The sCD146 levels of ankylosing spondUtis patients with peripheral joint involvement were significantly higher than the patients with axial involvement alone or the normal controls (P ＜ 0.05).The expression level of sCD146 in peripheral blood was positively correlated with disease activities of patients with ankylosing spondlitis. It may play important roles in the pathogenesis in ankylosing spondlitis.

Objective To investigate the blood-saving effect of tranexamic acid in patients undergoing Stanford type A aortic dissection surgery.Methods Fifty-six patients of both sexes with acute Stanford type A aortic dissection, aged 34-58 yr, weighing 62-84 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ , with their left ventricular ejection fraction ＞ 40％, undergoing emergency surgery, were randomly divided into 2 groups: control group (group C, n=26) and tranexamic acid group (group TA, n=30).Tranexamic acid was infused as a bolus of 10 mg/kg over 30 min before skin incision followed by an infusion of 10 mg · kg-1 · h-1 throughout the surgery in group TA.The equal volume of normal saline was given instead in group C.The total volume of drainage at 24 h after operation, the postoperative requirement of allogeneic red blood cells, fresh frozen plasma and platelets, and re-thoracotomy for bleeding were recorded.The postoperative mechanical ventilation time, duration of intensive care unit stay, and complications after operation were also recorded.Results Compared with group C, the total volume of drainage at 24 h after operation, and the requirement of allogeneic red blood cells, fresh frozen plasma and platelets were significantly reduced, the incidence of rethoracotomy for bleeding was decreased, the postoperative mechanical ventilation time, and duration of intensive care unit stay were shortened, and the incidence of postoperative acute lung injury and transient neurological dysfunction were decreased in group TA.Conclusion Tranexamic acid has blood-saving effect and can reduce postoperative bleeding and allogeneic blood transfusion in patients undergoing Stanford type A aortic dissection surgery.

Objective To observe the occurrence and risk factors of arrhythmia in chronic kidney disease (CKD) patients in different stages of renal function. Methods A total of 405 CKD patients were enrolled in this study and none of them received renal replacement therapy.The 24 h dynamic electrocardiogram (DCG) was performed,and baseline characteristics were compared.Multivariable Logistic regression analysis was used to examine the relationship between the severe arrhythmia and the potential risk factors,such as age,gender,CKD stage,diabetes,hypertension,hyperpotassaemia,left ventricular hypertrophy (LVH),etc. Results There were 69 patients (17.04％),79 patients (19.51％),82 patients (20.25％),88 patients (21.73 ％) and 87 patients (21.48％) in CKD stage 1,2,3,4 and 5,respectively.As high as 45.68％ of all the patients had severe arrhythmia,represented by 27.54％,29.11％,42.68％,57.95％ and 65.52％ in CKD stages 1-5 respectively.The occurrence of severe arrhythmia increased as the eGFR decreased in CKD stages 2,3,4 (p＜0.05).On multivariable Logistic regression analysis,the occurrence of severe arrhythmia was related to LVH,CKD stage,diaberes hyertension and hyperpotassaemia are signidicantly assoxiated with severe arrhythmia.