Objective To summarize treatment experiences of microsurgical clipping for anterior communicating artery aneurysm via pterional approach.Methods Clinical data of 82 cases undergoing microsurgical clipping for anterior communicating artery aneurysm via pterional approach in the first affiliated hospital of Kunming Medical University from October 2008 to December 2014 were collected and retrospectively analyzed.The patients were divided into different groups by Hunt-Hess illness grading scale,with 11 cases for level 0,7 cases for level Ⅰ,30 cases for level Ⅱ,25 cases for level Ⅲ,8 cases for level Ⅳ,and 1 cases for level Ⅴ.Twenty-one patients underwent operation at early stage of SAH (＜3d),15 at late stage of SAH (4d～2W),and 35 at prolonged stage of SAH (＞2W).The prognosis of patients was evaluated according to GOS classification criteria at discharge.Results A total of 85 ACoAA were found in 82 patients and all of them were clipped and,at the same time,3 aneurysms were resected and 11 thrombuses were punctured,cut and removed.In the operation,15 (17.6％) aneurysms ruptured again and temporary blocking happened for 73 times,with the shortest blocking time of 2 rmin,the longest of 40 rmin,and the average of 9.26min.According to GOS score,good recovery rate was 79.3％ (65/82),moderate disability rate was 12.2％ (10/82),severe disability rate was 3.7％ (3/82),vegetative state rate was 0％,and death rate was 4.9％ (4/82).Good recovery rates for the operations at early,late and prolonged stage of SAH were 85.7％,73.3％ and 82.3％ respectively and for level 0 to level Ⅴ were 90.9％,85.6％,86.7％ and 84.0％,25.0％ and 0.0％ respectively.Results of DSA or CTA re-examination upon 55 patients followed-up at discharge or three months after discharge showed that tumor pedicle were clipped and aneurysm disappeared.Fifty cases were followed up from four months to seven years after the operation,with one case of aneurysm recurrence.Another thirty-two cases were lost to follow-up.ConclusiornS Microsurgical techniques and microdissection are keys to successful operation.Pterional approach can guarantee successful clipping of aneurysms with different directions,locations and sizes.It is also an easy,effective and reliable approach with less postoperative complications.Operation for anterior communicating artery aneurysm should be performed as early as possible.

Objective:To compare and analyze the value of diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) of 1.5T magnetic resonance (MR) in differential diagnosis for localized prostate cancer, chronic inflammatory response and benign hyperplasia.Methods: 80 patients with localized prostate cancer were enrolled in the research. The signal to noise ratio (SNR) of DWI, ADC value and semi-quantitative classification of DWI on lesions were measured, and the diagnostic efficiencies of them were compared by using ROC curve.Results: In the 80 patients with localized prostate cancer patients, there were 52 malignant lesions and 43 benign lesions in peripheral band, and there were 31 malignant lesions and 46 benign lesions in central gland. The ADC values of prostate cancer in peripheral band and central gland were 0.91±0.12 and 0.86±0.15, respectively, and they were significantly lower than that of normal tissue (1.68±0.23 and 1.28±0.31) and benign lesions (1.24±0.21 and 1.12±0.16). The semi-quantitative classifications of DWI for benign lesions were significantly higher than that for malignant lesions in peripheral band and central gland, respectively (x2=20.88,x2=12.14;P<0.05). For the diagnostic efficiency of ADC, the sensitivities of benign and malignant lesions in peripheral band and malignant gland were 91.3% and 79.1%, respectively, and the specificities of them were 89.6% and 70.2%. And they was significant higher than the corresponding sensitivities (71.2% and 51.3%)and specificities (78.4% and 65.8%) of DWI imaging.Conclusion: Both of DWI and ADC of 1.5T magnetic resonance are the important indexes in differential diagnosis for prostate cancer, chronic inflammatory response and benign hyperplasia, while ADC value is better than DWI image in the clinical efficiency.

Objective To compare eradication rates,safety and compliance of minocycline quadruple and tailored therapies in patients retreated for Helicobacter pylori (H.pylori) infection.Methods Between January 2014 and June 2014,135 patients with dyspepsia (18-70 years) and H.pylori infection after at least one previous eradication treatment at a tertiary hospital were randomly assigned to a 10-day treatment with minocycline quadruple therapy versus tailored triple regimen of PPI,amoxicillin and a third antibiotic.In the group of tailored therapy,medications were adjusted based on clarithromycin sensitivity and cytochrome P450 isoenzyme 2C19 genotype.Eradication status was assessed 4-12 weeks after treatment.Results Although H.pylori eradication rates were higher in the minocycline therapy group than that in the tailored therapy group in intention-to-treat [84.1％ (95％ CI 75.0％-93.2％) vs 75.8％ (95％ CI 65.1％-86.5％),P =0.245] and per-protocol [88.3％ (95％ CI 80.3％-96.3％) vs 79.7％ (95％CI 69.7％-89.7％),P =0.197] analyses,the differences between the two groups were not statistically significant.The incidence of adverse effects and compliance between the two groups were also comparable.Conclusions The tailored therapy in this study had a poor eradication efficacy in the retreated patients with H.pylori infection.Minocycline quadruple therapy achieved a relatively satisfactory eradication efficacy and may be an alternative choice for the retreatment of H.pylori infection.Clinical trial registration Chinese Clinical Trial Registry,ChiCTR-TRC-13003975.

Objective: To compare the safety and efifcacy of platelet glycoprotein IIb/IIIa antagonist in treating STEMI patients by intracoronary-intravenous administration and intravenous administration.
Methods: We searched PubMed, Embase, Cochrane library, CNKI, VIPH and Wanfang database, the retrieval stopped at 2014-03. According to 5.0.2 Cochrane handbook, 2 scientists collected 2494 STEMI patients treated by IIb/IIIa antagonist from 20 references, and they were divided into 2 groups. Combination group, the patients received intracoronary, then intravenous administration, n=1258 and Intravenous group, the patients receive only intravenous administration, n=1236. RevMan 5.0 software was used for Meta-analysis.
Results: At 1 month after PCI treatment, compared with Intravenous group, the Combination group had better conditions of TIMI 3, TMP 3, ST segment recovery, MACE occurrence and MI area changes, all P<0.01; Combination group also showed better conditions of angina recurrence, death and post-operative target vessel revascularization, all P<0.05. LVEF was similar between 2 groups at 1 week after PCI. MI recurrence, post-operative bleeding and thrombocytopenia were similar between 2 groups at 1 month after PCI, all P>0.05.
Conclusion: Intracoronary-intravenous administration of platelet glycoprotein IIb/IIIa antagonist had the better effect for treating STEMI patients without increasing the side effects of post-operative bleeding and thrombocytopenia.

Objective To examine the expression of autoantibodies against angiotensin Ⅱ type 1 receptor (AT1-AAs),monocyte chemoattractant protein-1 (MCP-1) and high-sensitivity C-reactive protein (hs-CRP) in patients of acute coronary syndrome (ACS),and study the role of AT1-AAs in plaque stability and pathogenesis of ACS.Methods Sixty patients with ACS were selected as ACS group,60 patients with stable angina pectoris (SAP) were selected as SAP group,and 60 healthy people were selected as control groups.The epitopes of the second extracellular loop of angiotensin Ⅱ type 1 receptor (165-191) were synthesized and used as antigen to screen the serum autoantibodies by enzyme-linked immunosorbent assay (ELISA).The peripheral blood levels of MCP-1 and hs-CRP were also evaluated.Results The positive rates of AT1-AAs in ACS group,SAP group and control group were 45.0％(27/60),21.7％(13/60) and 5.0％(3/60),respectively.The positive rates of AT1-AAs in ACS group and SAP group were significantly higher than those in control group,the positive rate of AT1-AAs in ACS group was significantly higher than that in SAP group,and there were statistical differences (P ＜ 0.01).The MCP-1 and hs-CRP levels in ACS group and SAP group were significantly higher than those in control group,the MCP-1 and hs-CRP levels in ACS group were significantly higher than those in SAP group,and there were statistical differences (P ＜ 0.01).The MCP-1 and hs-CRP levels in AT1-AAs positive patients in ACS group and SAP group were significantly higher than those in AT1-AAs negative patients,and there were statistical differences (P ＜0.01).Conclusions AT1-AAs may play an important role in the pathogenesis of ACS.Inducing the expression of inflammatory factor through AT1-AAs maybe an important mechanism for plaque instability.

Objective: To evaluate the efifcacy and safety on clopidogrel combining proton pump inhibitor (PPI) for treating the patient after percutaneous coronary intervention (PCI) by Meta analysis.
Methods: We searched MEDLINE, EMBASE, Cochrane Library and conference databanks, the retrieval time ended at 2014-03 and 14 references were selected for Meta analysis by RevMan 5.2 software. A total of 52274 patients were enrolled and divided into 2 groups, Control group, the patients received clopidogrel, n=43809 and Combination group, the patients received clopidogrel and PPI n=8465. The efifcacy and safety were compared between 2 groups.
Results: Compared with Control group, the patients in Combination group showed increased all cause death rate (OR=1.20, 95% CI 1.05-1.37), re-myocardial infarction (MI) (OR=1.19, 95% CI 1.07-1.33) and in-steut re-vascularization (OR=1.22, 95% CI 1.08-1.39), all P<0.05; while the MACE (OR=1.29, 95% CI 0.98-1.69), in-stent thrombosis (OR=1.22, 95% CI 0.97-1.54) and gastro- intestinal bleeding (OR=0.95, 95% CI 0.55-1.67) were similar between 2 groups, all P>0.05. Further analysis found that PPI (such as omeprazole and esomeprazole) could compete the CYP2C19 enzyme location of clopidogrel, increase the risk of cardiovascular events and decrease the gastrointestinal protection.
Conclusion: Clopidogrel combining PPI may increase the risk of all cause death, MI, in-stent revascularization and decrease the gastrointestinal protection in patients after PCI, especially for omeprazole and esomeprazole which may compete the CYP2C19 enzyme location of clopidogrel.

Objective:To investigate the effect of astragaloside IV (AS-IV) on the secretion of stromal cell-derived factor-1α (SDF-1α) and CXC chemokine receptor 4 (CXCR4) by high glucose injured human umbilical vein endothelial cells (HUVECs), so as to lay a foundation for further study on AS-IV improving angiogenesis by regulating SDF-1 α/CXCR4 axis of endothelial cells.Methods:HUVECs were isolated and cultured from the umbilical vein of full-term healthy newborns and identified by von Willebrand factor (vWF) combined with 4-diamino-2-phenylindole (DAPI) nuclear staining. The obtained HUVECs was cultured in EGM-2 medium with 30 mmol/L glucose for 120 h to obtain high glucose damaged HUVECs. After intervention with different concentration gradients (25 mg/L, 50 mg/L, 100 mg/L, 200 mg/L, 400 mg/L) AS-IV for 72 hours, the contents of SDF-1α and CXCR4 were detected by enzyme linked immunosorbent assay (ELISA) method to determine the best concentration of AS-IV. The supernatant of damaged HUVECs were collected at 6, 12, 24, 48 and 72 hours after intervention with the best concentration of AS-IV, and the contents of SDF-1α and CXCR4 were detected by ELISA method to determine the best action time of AS-IV. The damaged HUVECs was randomly divided into experimental group and control group, and the blank group was set up at the same time. The experimental group was treated with the best concentration of AS-IV and the best time, the control group and the blank group were treated with the same volume of phosphate buffered saline (PBS) solution, and the contents of SDF-1α and CXCR4 in each group were detected by ELISA method.Results:The vWF factor on the cell membrane was green fluorescence, and the nucleus was blue after DAPI staining. When the fusion image showed green fluorescence, HUVECs were identified by blue fluorescence. The expression of SDF-1α in damaged HUVECs was the best when treated with AS-IV of 100 mg/L for 24 hours (1 642.87 pg/ml), and the expression of CXCR4 in damaged HUVECs was the best when treated with AS-IV of 50 mg/L for 48 hours (8.44 ng/ml). Compared with the control group, the contents of SDF-1α and CXCR4 in the experimental group were significantly increased, and the difference was statistically significant ( P<0.05). While the contents of SDF-1α and CXCR4 in the experiment group were slightly less than those in the blank group and there was no statistically significant difference ( P>0.05). Conclusions:AS-IV can promote the expression of SDF-1α and CXCR4 in HUVECs damaged by high glucose to return to normal physiological level, so as to play the role of vascular repair and neovascularization.

OBJECTIVETo investigate effectiveness of scopolamine on the acute severe chlorphenamidine poisoning patients.

METHODS72 cases of acute severe chlorphenamidine poisoning patients were divided into I and II groups by the principle of a 1:1 sampling according to the order of admission. The I group (36 cases) were treated with traditional multimodality therapy, including gastrolavage, catharsis, using reductant-oxidant (methylthioninium chloride and vitamin C), and symptomatic treatment. The II group were treated with traditional multimodality therapy and scopolamine at the same times. Blood methemoglobin were measured at 0, third, seventh, twelfth, twenty-fourth hour, serum troponin I (CTnI) and creatine kinase isoenzyme (CK-MB) levels at third, seventh, twenty-fourth, forty-eighth hour, hepatic and renal functions at third, twenty-fourth, forty-eighth hour, and electrocardiogram (ECG) were evaluated every 4 hours in 3 days after hospitalization on all patients. The two groups of patients were compared the efficacy and change detection of targets.

RESULTS31 patients (86.11%) recovered and 5 patients (13.89%) died in I group. All 36 cases recovered in II group. The recovery rate of II group was distinctively higher than that in I group (P < 0.05) and the difference was statistically significant (P < 0.05). The average recovery time and the length of hospital stay in II group were sharply shorter than those in I group (P < 0.01) and the difference was statistically significant (P < 0.05). Serum CTnI levels between seventh hour and forty-eighth hour, serum CK-MB levels between third hour and forty-eighth hour and methemoglobin concentration at third, seventh, twelfth, twenty-fourth hour were apparently lower in II group, and the difference was statistically significant (P < 0.05). The abnormal rates of hepatic and renal functions in II group were distinctively lower than those in I group and the difference was statistically significant (P < 0.05). The abnormal rates of ECG in the second and third day in II group were respectively 38.89% and 11.11%, and were lower than those in I group (64.71%, 38.71%). The difference was statistically significant (P < 0.05).

CONCLUSIONScopolamine has the excellent treatment effect on acute severe chlorphenamidine poisoning patients and protec their hearts, livers, and kidneys. It complements the deficiency of reductant-oxidants, and combination of the two drugs can form the synergy effect.

To develop a method of evaluating bone mass with CT numbers (Hounsfield unit, HU), volumetric mean of CT numbers (HUm) was defined to describe bone mass for the study of bone loss caused by microgravity. Ten femurs in the tail-suspended rats experiment were scanned by CT scanner. And the RUm of the intact, proximal, middle and distal femurs were obtained from these CT data. Then regressive analysis was performed between HUm and bone mineral density (BMD) measured by DXA in those regions. When HU threshold is equal to 400, the correlation between BMD and HUm of the intact femur is the best in all cases (R = 0.887, P <0.001), and the correlation between BMD and HUm of the proximal femur (R = 0.833, P <0.01) is better than those of the middle femur (R=0.683, P<0.05) and distal femur (R = 0.744, P<0.05). Volumetric mean of CT numbers has a good linear relationship with BMD; it can accurately describe bone mass and can be used to evaluate the results of the tail-suspended rats experiment.
Animals ; Bone Density ; Femur ; diagnostic imaging ; Radiographic Image Interpretation, Computer-Assisted ; Rats ; Tomography, X-Ray Computed ; methods

Objective: To investigate the relationship between lipid control level and in-stent restenosis (ISR) in patients after percutaneous coronary intervention (PCI). Methods: A total of 211 coronary artery disease (CAD) patients who received primary PCI in our hospital from 2012-01 to 2012-12 were studied. All the patients took oral dual anti-platelet therapy and statins routinely, and they received coronary angiography (CAG) re-examination at (3-12) months after PCI. According to CAG ifndings, the patients were divided into 2 groups: ISR group,n=25 and Non-ISR group,n=186. Blood levels of TC, TG, HDL-C, LDL-C were detected and compared before primary PCI and after CAG re-examination between 2 groups. Results: The baseline information such as age, gender, hypertension, family history of CAD, pre-operative diagnosis of coronary syndrome, smoking and drinking conditions were similar between 2 group,P>0.05; the pre-operative TC, TG, HDL-C, LDL-C were similar between 2 group,P>0.05. CAD patients combining with diabetes mellitus (DM) in ISR group (36.0%) was higher than that in Non-ISR group (17.7%),P=0. 03. Multivariate logistic regression analysis showed that at post PCI, no TC reduction (OR=1.07, 95% CI 0.38-2.62,P=0.04), LDL-C ≥ 1.8 mmol/L or the reduction less than 50% (OR=11.33, 95% CI 3.62-35.52,P<0.01), combining with DM (OR=3.00,95% CI 1.04-8.67,P=0.04) were positively related to ISR. Conclusion: Without TC reduction and nonstandard LDL-C level were the risk factors of ISR occurrence in CAD patients after PCI, DM complication may signiifcantly increase the risk of ISR.