Objective To compare the effect of transthoracic contrast echocardiography (cTTE) with transesophageal contrast echocardiography (cTEE) for detecting right to left shunt (RLS) in patients with patent foramen ovale (PFO). Methods The prospective study was conducted in 29 consecutive patients with PFO who suffered from cryptogenic stroke and/or migraine. Contrast echocardiography was performed in all 29 patients. The cTTE was performed using transducer with second harmonic imaging modality (transmitting frequency 1.7 MHz, receiving frequency 3.4 MHz). The cTEE was performed using transducer with frequency 7 MHz. Ten milliliter saline solution of contrast were rapidly administrated through an antecubital vein. According to whether microbubble (MB) appearing in left atrium after complete opaciifcation of right atrium within the ifrst 3 circles, the results were classiifed by a four-level semi-quantitative categorization:Level 1 (no PFO-RSL), no MB in left atrium; Level 2 (small PFO-RSL) 1-10 MBs; Level 3 (medium PFO-RSL) 10-30 MBs;Level 4 (large PFO-RSL)>30 MBs. Results The total detection rate of PFO-RSL was signiifcant different between cTTE and cTEE (86.2%vs 55.2%,χ2=5.711, P=0.017). In cTTE there were 4 cases at level 1, 1 case at level 2, 5 cases at level 3 and 19 cases at level 4. In cTEE there were 13 cases at leverl 1, 2 cases at level 2, 6 cases at level 3 and 7 cases at level 4. The comparison of semi-quantitative grading derived from cTTE and cTEE was also signiifcant different (Wilcoxon signed ranks test showed Z=-3.789, P=0.000). Conclusions The efifciency in detection of PFO-RLS with cTTE was better than with cTEE. Compared with cTEE, cTTE was easier in practice and brought less discomfort and complications to patients.

Objective Analyze the causes of ambiguous medical records to provide evidence for the DRGs.Methods 268 Ambiguous medical records were selected from 17 751 surgery medical records between 2010 and 2014 based on major diagnosis and major surgery.The single factor Chi-square test was used to study the influence of various inpatient characteristics on the occurrence of ambiguous medical records, and those significant variables were given assignment to find influencing factors of ambiguous medical records by using logistic regression analysis.Results Ambiguous medical records account for 1.51％ of all surgical medical records.Logistic regression analysis results show that such risk factors as discharging from internal medicine, death of patient, transfer between departments, elderly, long time of hospitalization, and tumor patients, as contributing to ambiguous medical records.All the results are statistically significant (P＜0.05), including discharging from which departments (OR=6.595, 95％CI..5.043 ～ 8.625), death of patient (OR=3.787, 95％ CI: 2.611 ～ 5.492) and transfer between departments (OR =2.746, 95％ CI: 2.061 ～ 3.659), which rank important risk factors for ambiguous medical records.Conclusion Analysis of the causes of ambiguous medical records provides important evidences for the hospital to improve its medical record quality management.

Animals ; Gene Expression ; Mice ; Mice, Inbred Strains ; Spinal Cord ; metabolism ; Spinal Cord Injuries ; genetics ; metabolism ; p21-Activated Kinases ; genetics

Objective To investigate the effect of sevoflurane postconditioning on the activities of Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase during myocardial ischemia-reperfusion (I/R) in rats and the possible mechanism. Methods Forty-five healthy male Wistar rats weighing 250-280 g were randomly divided into 3 groups ( n = 15 each): sham operation group (group S), I/R group and sevoflurane postconditioning group (group Spo). Myocardial I/R was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 120 min of reperfusion. In group S the anterior descending branch was only exposed but not ligated. Group Spo received 5 min inhlation of 2.5% sevoflurane 1 min before reperfusion. The myocardial tissues were taken at 2 h of reperfusion for determination of infarct size and activities of Na+ -K+ -ATPase and Ca2 * -Mg2 * -ATPase. Results The infarct size was significantly larger and the activities of Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase were signifi cantly lower in group I/R than in group S ( P ＜ 0.05). The infarct size was significantly smaller and the activities of Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase were significantly higher in group Spo than in group I/R (P ＜ 0.05 ). Conclusion Sevoflurane postconditioning can reduce myocardial I/R injury through increasing the activities of Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase.

OBJECTIVETo investigate the protective effects of Jiedu Tongluo injection on cerebral edema induced by focal lesion of cerebral ischemia/reperfusion, the hydrous content of brain and the expressions of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin and MMP-9 in rats.

METHODThe model of brain middle cerebral artery ischemia/reperfusion was established by the thread approach. After 24 hours of reperfusion, cerebral edema formation was determined by the hydrous content of brain. The permeability of blood brain barrier was evaluated based on the leakage of Evans blue. Enzyme-linked immunoadsordent assay (ELISA)was used to examine the expression of ICAM-1, VCAM-1, E-selectin. The expression of MMP-9 was measured by immunohistochemistry.

RESULTJDTL, in the dose of 2 mL x kg(-1) and 4 mL x kg(-1), relieved cerebral edema (P < 0.05, P < 0.01), reduced the expressions of ICAM-1, VCAM-land E-selectin and decreased MMP-9 activity (P < 0. 05, P < 0.01) in model rats.

CONCLUSIONJiedu Tongluo injection has a protective effect on rat brain from cerebral edema induced by the injury of focal cerebral ischemia/reperfusion. The mechanism is related to that Jiedu Tongluo injection can reduce the expressions of ICAM-1, VCAM-1 and E-selectin and inhibit of MMP-9 activation in rat brain.

Animals ; Blood-Brain Barrier ; drug effects ; metabolism ; Brain Edema ; etiology ; metabolism ; prevention & control ; Brain Ischemia ; complications ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; E-Selectin ; metabolism ; Evans Blue ; metabolism ; Gene Expression Regulation, Enzymologic ; drug effects ; Injections ; Intercellular Adhesion Molecule-1 ; metabolism ; Male ; Matrix Metalloproteinase 9 ; metabolism ; Permeability ; drug effects ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; complications ; Vascular Cell Adhesion Molecule-1 ; metabolism

Background Application of confocal microscopy in the investigation of ocular surface system in living eye have been greatly extended in two decades.In vivo confocal microscopy allows the evaluation of the normal or pathological tissue at the cellular level.However,seldom study about the morphology of normal in vivo human bulbar conjunetiva under the confocal microscopy was induced. Objective Present study was to analyze the appearance of normal bulbar conjunetiva cells under the in vivo confocal microscopy. Methods Laser scanning confocal microscopy was used to examine the morphological characteristics of the bulbar conjunetiva in 21 eyes of 15 healthy volunteers.The parameters of confocal microscopy were as follows:resolution 1 μm,wave length 670 nm,field range 400 μm×400 μm.The epithelial cell numbers,dendritics cells density and goblet cells density from superior,inferonasal,nasal and temporal bulbar conjunctiva were calculated respectively and compared and imaged by the HRT3 Rostock Cornea Modual. Results The superficial epithelial cells of the bulbar conjunctiva was seen with the small cell nuclei and blur border.The borders of basal epithelial celt were clearly visible without cell nuclei.The presumed goblet cell presented with a large hyperreflective oval-shaped cell with relatively homogeneous brightness,crowed in groups or mainly dispersed.The orfices at the epithelial surface represented the goblet cells,showing some open and expel contents.The dendritic cell appeared to be hyperreflective corpuscular particles with visible processes among conjunetival epithelial cells.A few dense white fiber meshwork was exhibited in conjunctival stroma with the traverse blood vessels containing cellular elements.The superficial and basal epithelial cell densities were 2556±692and 2985±376 cells/mm2 respectively,and overall goblet and mature dendritic cells densities were 77±39 and 26±35 cells/mm2 respectively.Significant differences were proved in globet cell density and dendritic density among different conjunetival zones(P=0.001,P=0. 000),however,the alteration of conjunetival epithelium cells was insignificant in different area(P=0.204,P=0.130).Conclusion Confocal microscopy is a useful tool for the study of morphology of human bulbar conjunctiva cells in vivo.which offer a valuable aid in the diagnosis of ocular surface disease.

Background It is well known that the diminution of visual acuity appears before notable complications in some high myopic eyes.However,whether the impaired vision is associated with the change of retinal thickness at macula area is still under investigation.Objective This study was to investigate the relationship of macular retinal thickness with the change of visual acuity in high myopic eyes.Methods A consecutive caseobservational study was performed.Two hundred and forty-five eyes of 132 patients with the diopter of-6.00～-20.00 D were enrolled in this study during the January 2011 to January 2012 in Beijing Tongren Eye Center.All of the patients received the measurement of retinal thickness with Fourier Domain Optical Coherence Tomography (FDOCT),and the scan mode was MM6.The eyes were divided into the corrected vision ≥0.9 group and the corrected vision ≤0.8 group.In addition,the eyes were assigned to the non-posterior staphyloma group,posterior staphyloma Ⅰ group (macular symmetry) and posterior staphyloma Ⅱ group (macular gradient).The retinal thicknesses in different quadrants at the macular zone were measured and calculated by OCT software.Results The demography was matched in different groups.Corrected visual acuity was significantly increased in the corrected vision ≥ 0.9 group than that in the corrected vision ≤0.8 group (1.02±0.16 vs.0.62±0.08) (t=3.233,P=0.001).Retinal thickness value at fovea was (256.28±13.19) μm in the corrected vision ≥0.9 group,and that in the corrected vision ≤0.8 group was (231.17 ± 10.96) μm,with a significant difference between the two groups (t =2.134,P =0.031).The corrected visual acuity was 1.00±0.27,0.78±0.21 and 0.90±0.13 in the non-posterior staphyloma group,posterior staphyloma Ⅰ group and posterior staphyloma Ⅱ group,respectively,showing significant difference among the three groups (F=15.760,P=0.015),and the corrected visual acuity of the non-posterior staphyloma group and posterior staphyloma Ⅱ group were significantly higher than that of posterior staphyloma Ⅰ group (q =16.131,P =0.006 ; q =-10.831,P=0.008).A significant difference also was seen in the mean retinal thickness among the three groups (F=2.316,P =0.025).The mean retinal thickness in the posterior staphyloma Ⅰ group was (234.21 ± 15.69) μm,which was significantly smaller than (252.25± 15.31) μm of the posterior staphyloma Ⅱ group (q =12.977,P =0.023).There were no significant difference in the retinal thickness at para-fovea area among the three groups (F=0.318,P =0.078).However,significant difference was found at peri-fovea area in different groups (F=1.925,P =0.013).The mean retinal thicknesses at peri-fovea area was (273.26 ± 16.37) μm in the posterior staphyloma Ⅱ group and was significantly smaller than (289.11 ± 19.30) μm of the posterior staphyloma Ⅰ group and (290.33 ± 17.12) μm of the non-posterior staphyloma group (q =-8.305,P =0.023 ; q =-7.011,P =0.012).Conclusions The retinal thickness at fovea is associated with the corrected visual acuity in high myopic eyes.The thinning of retinal thickness at the vertex of posterior staphyloma is one of causes of visual function impairment.

Objective To study the COLIXA3 gene polymorphism of patients with fluorosis and to explore the pathogenesis of COLIXA3 gene in endemic fluorosis.Methods Fifty one cases of patients with drinking-water borne fluorosis were selected as the case group in Xinzhou city,Shanxi province and 28 cases of healthy people were as the control group.Dental fluorosis was detected by Dean method and skeletal fluorosis was examined by X-ray.COLIXA3 of exon 5 gene product of 103 points was amplified by PCR and the gene locus genotype was sequenced.Results Ten cases of mild dental fluorosis,14 cases of moderate dental fluorosis,15 cases of severe dental fluorosis were detected among the 51 patients.The control group was free of dental fluorosis.All the 51 cases of patients with fluorosis had varying degrees of skeletal fluorosis,mainly osteosclerosis lesions,accounting for 86.27％(44/51 ),and mild skeletal fluorosis patients were all osteosclerosis lesions,and osteosclerosis lesions and multiple skeletal lesions were found among moderate and severe skeletal fluorosis patients in the case group,while control group had no skeletal fluorosis.The differences between genotypes of frequency distribution of AA,Aa,aa of COLIXA3 of case and control groups were not statistically significant [96.08％(49/51 ),3.92％(2/51 ),0.00％(0/51) and 96.43％(27/28),3.57％(1/28),0.00％(0/28),x2 =0.94,P ＞ 0.05].ConclusionsCOLIXA3 gene polymorphism is not significantly correlated to fluorosis.

Objective To explore whether different degrees of fluorosis influence the expression of cartilage COLIXA3 protein in fluorosis model rats. Methods Forty male Wistar rats 3 to 4 weeks old were randomly divided into 5 groups according to body mass, and these rats were fed with distilled water containing sodium fluoride(NaF) of 0(control), 25, 50, 100 and 150 mg/L for 6 months, respectively, in order to establish the animal model of drinking water type fluorosis. Pathomorphologieal changes of the osseous tissues of rats were analyzed under light microscope and transmission electron microscope, and the expression of COLIXA3 protein of femur metaphysis was examined by immunohistochemistry. Results HE staining showed different degrees of femoral metaphyseal ossification of cartilage in each experimental group, bone density increased, with sclerotic lesions of skeletal fluorosis. The control group showed no abnormal cartilage. Electron microscopy showed that the experimental groups with varying degrees of cartilage cell swelling, cell matrix fades, 50 mg/L group .showed hyperplasia, and 100,150 mg/L groups were observed with organelles decreased, part of the disintegration of the cartilage cell lacunae, lmmunohistochemical staining of rat chondrocytes COLIXA3 was positive, cytoplasm with brown granules, cartilage COLIXA3 protein expression(23.3 ± 4.5, 41.2 ± 5.6, 26.4 ~ 7.5) in the 25, 50 and 100 mg/L groups enhanced. Compared to the control group (6.1 ± 3.5), the expression of 50 and 100 mg/L groups was significantly increased, and the differences were statistically significant(all P < 0.05). The expression(13.3 ± 4.2)of COLIXA3 protein in 150 mg/L group was decreased compared with the previous three, but is still higher than that of control, and the difference was not statistically significant(P > 0.05). Conclusions There has pathological changes of sclerosing skeletal fluorosis in animal model. Low-dose fluoride promotes while high-dose inhibits cartilage cell proliferation. When fluorine concentration in external environment is too high and with extended exposure to fluoride, direct toxic effects of fluoride on cartilage cells is observed. Fluorine affects and promotes the expression of COLIXA3 protein in cartilage. Low-dose fluoride can promote COLIXA3 protein expression, as the dose increases (over 100 mg/L), the effect decreases.

ObjectiveTo study the relationship between expression of a3 chain of collagen Ⅸ (COLIXA3)mRNA in the population exposed to fluorine and fluorosis,in order to reveal the role of COLIXA3 gene in the pathogenesis of endemic fluorosis.MethodsTwelve cases of mild drinking water-born skeletal fluorosis were selected as case groups in Regiment 123 and 128 of Xinjiang Production and Construction Corps Seven Division,6cases of healthy people living in fluorosis areas for more than 10 years as a internal control group and 6 heathly cases living in non-fluorosis areas for more than 10 years as a external control group.The expression of COLIXA3mRNA of peripheral blood lymphocyte of skeletal fluorosis patients and control groups were determined by using SYBR Green Ⅰ chimeric fluorescent method for real-time quantitative PCR.ResultsThe results of the relative expression of COLIXA3 mRNA of case group,internal control group and external control group were 2.16 ± 0.62,1.06 ± 0.09 and 1.05 ± 0.12,respectively.The COLIXA3 expression in case group was significantly higher than that of the internal control group and the external control group (all P ＜ 0.05),while the difference of COLIXA3expression between the internal control group and the external control group was not significantly different (P ＞0.05).ConclusionsFluorine contributes to the expression of COLIXA3 mRNA in peripheral blood lymphocyte,and the expression is up to 2 times higher than that of the control groups,meaning potential biomarkers.