Objective To explore the risk factors and imaging features of silent brain infarction (SBI).Methods The patient with SBI from the clinic were enrolled in the study,and the patients with symptomatic non-lacunar infarction served as controls.The risk factors and imaging features of both groups were compared.Results Among 145 patients with SBI,133 (91.72％) had two or more lesions,mainly in the centrum semiovale (73.10％).The proportion of patients with white matter lesions in the group of SBI in a single location was significantly lower than that in the group of SBI in multiple locations (41.67％ vs.73.68％ ;x2 =5.484,P =0.019).Compared to the patients with SBI,the age in patents with symptomatic non-lacunar infarction was older (72.42 ± 11.79 vs.67.03 ± 12.04 years; t =3.545,P =0.000),the proportions of male (63.55％ vs.46.21％ ;x2 =7.447,P =0.006),hypertension (80.37％ vs.64.14％ ; x2 =7.887,P =0.005) and atrial fibrillation (31.78％ vs.8.97％,x2 =21.113,P =0.000),as well as the levels of fasting glucose (6.09 ±1.23 mmol/Lvs.5.65± 1.18 mmol/L; t=2.863,P=0.005),total cholesterol (5.53± 0.74 mmol/Lvs.5.27 ± 0.90 mmol/L; t =2.554,P =0.011),triglycerides (1.89 ± 0.20 mmol/L vs.1.77 ± 0.18 mmol/L; t =4.910,P=0.000) and homocysteine (1 4.88 ±4.97 mmol/L vs.11.94 ±4.61 mmol/L; t =4.432,P =0.000)were higher.However,the lipoprotein (a) level was lower (0.18 ± 0.06 g/L vs.0.27 ± 0.18 g/L; t =-5.489,P =0.000).Among patients with SBI,33.8％ and 43.5％ had lesions in two and three locations,respectively;among patients with symptomatic non-lacunar infarction,66.4％ and 27.1％ had lesions in a single location and two locations,respectively (P ＜ 0.001).Multivariate logistic regression analysis showed that lipoprotein (a)was the independent risk factor for SBI (odds ratio 5.988,95％ confidence interval 2.421-14.706; P =0.000).Conclusions Although they shared a variety of common risk factors,patients with SBI had less atherosclerotic risk factors than those with symptomatic non-lacunar infarction.Most patients with SBI had lesions in multiple locations.

Objective To investigate the anesthetic management of perventricular closure of ventricular septal defects (VSD) under transesophageal echocardiography. Methods A retrospective review of the clinical data of 52 children who underwent perventricular closure of VSD under transesophageal echocardiography were analyzed. All the children were performed tracheal intubation under general anesthesia, and the electrocardiogram, pulse blood oxygen saturation, invasive arterial pressure, central venous pressure, end tidal carbon dioxide partial pressure, temperature and urine output were continuously monitored throughout the procedure. The transesophageal echocardiography was necessary for guiding transcatheter or per-ventricular device placement. Results Perventricular closure of VSD was successfully completed in 51 children under transesophageal echocardiography, the operation time was (76.7 ± 36.4) min, the anesthesia time was (89.5 ± 27.1) min; 1 child was converted to open surgical repair. Conclusions The intraoperative transesophageal echocardiography technology is the key to the success of the surgery. At the same time of analgesia and sedation, the anesthesia doctor needs to pay attention to the changes of hemodynamics in children.

Objective To sequence and analyze the full-length genome of one HEV strain,W2-1 isolated from a sporadic hepatitis E patient hospitalized in 1999 in Xinjiang,China.Methods Nested RT-PCR assays with 4 sets primers were used to amplify the entire genome.The PCR products were purified and sequenced.The full-length genome was acquired by assembling the fragmental sequences using the DNAstar 5.01 software.The genome of W2-1 was analyzed by comparing with the reference HEVs from GenBank.Results The complete genome of W2-1 is 7212 nt in length,including three open reading frames (ORF1-3) with 5079,1980 and 345 nt respectively,27 nt 5'UTR and 83 nt 3'UTR,and a 3' poly A tail.Phylogenetic analysis based on full-length genome showed that W2-1 belonged to genotype 1,subtype 1b.W2-1 had high homology with the HEV strains isolated in the large hepatitis E epidemic in Xinjiang in 1987-1989,sharing 97.2％-98.5％ nucleotide identity in the full length genome.W2-1 also showed high homology with 1b strains isolated in China after 2000,with 97.6％-99.2％ nucleotide identity.The specific amino acid sites in ORF1-3 proteins that distinct between genotype 1 HEV and the potential zoonotic strains did not change in W2-1.Conclusion W2-1 belongs to subtype 1b.The study indicates subtype 1b HEV has been circulating in China in a long period after hepatitis E outbreak in Xinjiang in 1986-1989.The amino acids of ORF1-3 of subtype 1b are conserved.

Objective To study the clinical significance of urinary hTERT in diagnosis and follow up of transitional cell carcinoma of urinary bladder.Methods Semi-quantitative RT-PCR was used to detected the expression of hTERT mRNA expression in 42 cases with bladder transitional carcinoma and 40 patients without carcinoma of bladder.Regular urine cytology results were compared with the expression of hTERT.Following-up observision of the changes of hTERT mRNA expression and its relation with recurrency in 36 cases of transitional cell carcinoma of urinary bladder was conducted.Results 30 0f 42 cases with bladder transcriptional carcinoma were found positive expression of hTERT.but only 3 in the control group of 40 cases presented the positive expression of hTERT.The overall sensitivity and specificity for hTERT were 71.43%and 92.50%.The sensitivities for hTERT were 50.00%,73.68%and 90.91%respectively in G1-G3 tumor.The urine hTERT expression level significantly increased with the tumor grade and clinical staging.The sensitivity and the specificity of urinary cytology were 19.05%and 100%.Compared with hTERT.the cytology had lower sensitivity and no difference in specificity.The recurrence of the tumor was found in 6 patients.8-16 weeks after positive expression of hTERT,cystoscope confirmed recurrence of bladder carcinoma.Conclusions hTERT is a tumor marker of transcriptional carcinoma of bladder.because of its relatively high sensitivity and specificity.Detection of hTERT in urine sediment is superior to traditional cytology.The urine hTERT rate significantly increases with the tumor grade and the clinical stage.hTERT can indicate recurrence of bladder carcinoma.so it is valuable to the monitoring of recurrence of transcriptional cell carcinoma of bladder.

OBJECTIVE:To discuss the preparation methods of polyaspartate derivatives as drug delivery systems. DATA SOURCES:An online search of Elselvier,ACS publications and Springerlink between January 1990 and January 2006 was undertaken by using the keywords of "polyaspart*,hydrogels,micelles,complexes" to identify the relevant articles published in English.Meanwhile,Chinese journals full-text database were scanned with computer to search relevant articles published from January 1995 to October 2005,and the keywords were"asparmide,complexes,hydrogels,release" with language limited to Chinese.STUDY SELECTION:All the related data were analyzed to select those were aimed directly at the criteria.As for the arti cles in the same field,those published recently or published in the authority journals were preferred. DATA EXTRACTION:A total of 56 articles about the preparation methods of polyaspartate derivatives as drug delivery systems were collected, and 29 of them were in accordance with the inclusion criteria. DATA SYNTHESIS:Polyaspartate derivatives are new biodegradable and biocompatible materials.Covalent complexes, hydrogels and micelles,three main drug delivery systems of polyaspartate derivatives,exhibit good biocompatibility and conspicuous effect of control-release.CONCLUSION:With the help of the short synthesis route,simple manipulation,high production rate, the excellent biocompatibility as well as the better hydrophile,the polyaspartate derivatives are prone to reacting with other compounds for the modification.It is noted that the controllability of the control-release systems will be well improved through the researches of the influence factors of the degrading velocity and the new modifying method,additionally,the polyaspartate derivatives will be applied in the drug delivery field widely.

Objective To investigate the clinical application of renal vessel angiography with 256-slice spiral CT in laparoscopic surgery for renals.Methods One hundred and fifty-five cases underwent computed tomograph angiography(CTA) who were all confirmed by operations.According to preoperative renal artery CTA case shown,the initial plan intraoperative renal artery was compared with the situation with the actual surgery.AIl axial images were reconstructed using technique.Results All patients underwent preoperative renal artery CTA operative findings correspond with the actual rate of 100％.CTA stereoscopic images were good at reflecting renal vascular anatomy and ectopic blood vessels line.Conclusion CTA can accurately evaluate out of shape and variation of the renal arteriesvariation.It has important significance of processing of renal arteries intraoperative rapid,dealing with the renal artery accurately and reducing blood loss or damage and other complications.

AIM: To study the effects of vitamins on vascular activity elements in rabbits with atherosclerosis risk factors to determine whether vitamins have a role in preventing atherosclerosis. METHODS: 26 male Chinese rabbits were randomly divided into 3 groups. The first group was fed with normal feed as control group (n=6) .The other two groups were fed with normal feed plus cholesterol, lard and methionine as model group (n=10) and vitamin treatment group (n=10) respectively. In addition, the vitamin group was given multi-vitamin daily by gastrogavage. The experiment lasted for 8 wk. The vascular activity elements of the three groups were detected by radioimmunoassay and nitrate reductase respectively ,and the aorta pathological sample was prepared. RESULTS: In model group, the levels of plasma endothelin and thromboxane B 2/6-keto-prostaglandin F l? were significantly increased compared with control group, but serum nitric oxide showed no obvious changes between both groups. In vitamin group, the levels of plasma endothelin and thromboxane B 2 were significantly decreased, and the levels of 6-keto-prostaglandin F1? and nitric oxide were significantly increased compared with model group. In model group, there were significant pathological lesions, but the lesion was decreased by vitamin treatment. CONCLUTION: The vitamins supplement can alleviate or block the impairment of vascular endothelia caused by atherosclerosis risk factors, and help adjust the equilibrium of vascular activity elements. Therefore vitamins may play a positive role in preventing atherosclerosis.

ObjectiveTo evaluate the efficacy and safety of spironolactone in treatment NYHA (New York Heart Association) class Ⅰ - Ⅱ heart failure patients. MethodsEighty eight patients with NYHA classⅠ- Ⅱheart failure were randomized to sprionolactone or placebo groups.Patients were assessed by echocardiography and 6-minute walking test (6MWT) ,plasma aldosterone and NT-proBNP were measured before and 6 months after treatment; serum potassium and creatinine were monitored through the study. ResultsThe E/A and E/E' in spironolactone group were significantly lower than those of control group (1.2±0.7 vs. 1.7±0.6, P=0.007;15.2±2.3vs. 17.7±3.0, P=0.000). No differences were observed in left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF)between two groups after treatment. Left ventricular mass index (LVMI) in spironolactone group decreased after theatment [(117 ±27) g/m2 vs.(112 ± 19) g/m2,P = 0.044]. Plasma aldosterone level in spironolactone group after treatment was significantly lower than that of control group [ ( 157 ± 16) ng/L vs.( 165 ± 16) ng/L, P =0. 021 ]. Although there were no differences in plasma NT-proBNP level between two groups after treatment, it decreased significantly comparing with that of before treatment ( P = 0. 000). No differences were observed in serum potassium and creatinine between two groups after treatment. However serum potassium and creatinine in spironolactone group increased significantly after treatment [ ( 83 ± 18 )pmol/Lvs. (87 ± 22) μmol/L, P =0.047; (4.4 ±0.4) mmoL/L vs. (4.5 ±0.6) mmol/L, P =0. 012]. ConclusionSpironolactone can alleviate cardiac remolding and diastolic function in NYHA classⅠ - Ⅱ heart failure patients.

Objective To investigate the imaging features of hippocampus and entorhinal cortex in the normal,mild cognitive impairment(MCI) and Alzheimer's disease (AD),and explore the value of diagnosing MCI and AD by using the method of MRI measuring the volume of hippocampus and entorhinal cortex.Method One hundred and twenty-two people including 42 cases of MCI,38 cases of AD,and 42 cases of noroal cognition(NC) were selected as our subjects from health examination persons both in hospital and outpatient service.All were performed general examination and neuropsychological scale evaluation.The volume of hippocampus and entorhinal cortex were measured by using MRI.The correlation between the volumetric changes of hippocampus and entorhinal cortex with scores of mini-mental state examination (MMSE) and Montreal Cognitive Assessment(MoCA) was analyzed.Results The volume of hippocampus and entorhinal cortex in the MCI group,AD group and NC group were (6.29 ± 1.13)cm3 and (2.71 ± 0.51) cm3,(6.27 ± 1.11) cm3 and (2.09 ±0.68) cm3,(7.01 ±0.92) cm3 and (3.12 ±0.34) cm3 respectively.The volume of MCI group was obviously smaller than that of NC group (P ＜ 0.05).The volume of AD group was smaller than that of NC group(P ＜0.01).The volume of AD group was obviously smaller than that of MCI group(P ＜0.01).There was positive correlation between hippocampus volume,the volume of entorhinal cortex and MMSE scores (r =0.770,0.811 ; P ＜ 0.01).Meanwhile,hippocampal volume,volume of entorhinal cortex were positive correlated with MoCA (r =0.810,0.842; P ＜ 0.01).Conclusion The atrophy of entorhinal cortex and hippocampus is closely related to cognitive disorder.The MRI measuring of the volume of entorhinal cortex and hippocampus has a potential value in diagnosing and distinguishing of MCI and NC.

Objective To explore the clinical results and complications of the traditional skeletal traction through olecranon on treating the irreducible humeral supracondylar fracture in children with of ulna.Methods Ninety-eight children patients of humeral supracondylar fracture with failure of reduction manipulation were selected as our subjects.The towel clamp-skeletal traction through olecranon of ulna was applied as the additional treatment methods.Meanwhile 5-24 months' follow-up were performed.Results According to Flynn elbow joint function evaluation standard.The curative effect was as followed.71 patients (74.7％) got the excellent outcome,17 patients (17.9％) for good outcome and 7 patients for improved utcome(7.3％).Therefore,the ratio of excellent operation reached to 92.6％.Conclusion The towel clampskeletal traction through olecranon of ulna might be an effective method to treat reliable fixation regarding of its high curing rate and simple process of performance.