Objective To investigate the methods of reducing radiation dose in CT coronary angiography through optimizing individualized scan dosage protocol.Methods Two hundred patients (group A)underwent coronary CTA examination which was performed with fixed 120 kV and variable mA according to their BMI.The mA was set as 150-300 mA(BMI ＜ 18.5 kg/m2),300-500 mA (18.5 kg/m2 ≤ BMI ＜ 25.0 kg/m2),and 500-800 mA(BMI ≥ 25.0 kg/m2).When all examinations were finished,a linear regression was employed to analyze the correlation between mA and BMI,body surface(Suf),image noise(SD)respectively.The results of the analysis were used to formulate a regression equation,which was further used to establish a table list for quick search on how much mA that individualized coronary CTA scan would need.Another 200 patients(group B)enrolled for the individualized scan were scanned under new protocol that previous study established.The tube voltage was 100 and 120 kV.The tube current was variable according to the data in the table list.One-way ANOVA and Kruskal-wallis H test were used for statistics.Results Regression equation between mA and BMI,Suf,SD was:mA =17.984 × BMI + 169.149 × Suf-2.282 × SD-361.039.The SD(group A:32.08 ± 5.80,group B:28.60±4.47),dose index volume(CTDIvol)[group A:(41.97 ± 11.37)mGy,group B:(33.18±10.07)mGy],effective dose(ED)[group A:(10.91 ±3.07)mSy,group B:(8.83 ±2.72)mSv]had significant differences between the two groups(F =43.45,63.71,49.07 respectively,P ＜0.01 for all).The SD and ED results obtained in group B were better than those in group A.Conclusion Better performances were obtained when BMI combined Suf was used as a new individualized protocol than when BMI was used only,which means good image quality and lower radiation dosage in coronary CTA examination.

Objective To observe the effect of T-2 toxin on growth and development of rat epiphyseal plate of left knee and metaphyseal bone of femur and tibia in normal and low nutritional status, to find out possible pathogenic factors of Kashin-Beck disease and provide experimental basis for early intervention. Methods Ninety 3-week-old Wistar rats, weighing 60 - 70 g, were randomly divided into three groups: control group(general feed), T-2 toxin + general feed group, T-2 toxin + low nutrition feed group, thirty rats in each group with equally sex ratio. T-2 toxin (1.0 mg/kg) was administered orally 5 times a week via a gavage needle for 4 weeks. The change of hair, activity and body weight was observed. After 1, 2, 4 weeks, the epiphyseal plate of left knee and metaphyseal bone of femur and tibia (including distal femur and proximal tibia) were collected. Specimens were processed with HE and Masson staining. The morphology of chondrocytes and matrix collagen content in epiphyseal plate was observed. Trabecular bone volume fraction in tibial metaphyseal bone was analyzed by Image-Pro Plus 6.0 software. Results In the control group, rats were in good movement and hair with light, but in T-2 toxin + general feed group and T-2 toxin + low nutrition feed group, rats were found with reduced activities and hair with dark color. Body weights(g) of the control group, the T-2 toxin + general feed group and the T-2 toxin + low nutrition feed group were 81.0 ± 6.2, 79.0 ±5.1, 77.0 ± 7.5, respectively, by the end of first week; 101.8 ± 6.7, 97.0 ± 6.8, 93.0 ± 5.3, respectively, by the end of second week; 151.1 ± 15.7, 126.5 ± 11.9, 106.5 ± 11.5, respectively, by the end of fourth week. There was significant difference in groups by second week and the fourth week (F = 9.72, 41.65, all P ＜ 0.05 ). There was significant difference among multi-groups by the fourth week(all P ＜ 0.01 ). Under light microscope, at the second weeks, coagulative necrosis of chondrocytes was found in hypertrophic zone in the two groups with T-2 toxin; at the fourth weeks, cell necrosis increased. Masson staining showed collagen staining in the two groups with T-2 toxin significantly turned to clear pale coloration, indicating that the collagen matrix was significantly reduced. Image analysis showed there was significant difference in groups at the second and fourth week(F= 9.72, 41.65, all P＜ 0.05)in tibial metaphyseal trabecular bone volume fraction. There was significant difference between T-2 toxin + low nutrition feed group[(0.55 ± 0.12)％, (0.21 ± 0.0)％] and control group[(0.67 ± 0.09)％, (0.51 ± 0.14)％] by the second and fourth week(all P ＜ 0.01 ). Conclusions Under normal nutritional status, T-2 toxin can induce hypertrophic epiphyseal cartilage necrosis, collagen content decreased in epiphyseal plate, metaphyseal trabecular bone formation disorders; in the low nutritional status, T-2 toxin can lead to rat epiphyseal necrosis and significant metaphyseal bone disorder, but whether the performance is related to Kaschin-Beck disease needs to be studied further.

OBJECTIVETo analyze the inpatient cost of AIDS related opportunistic infection in a high HIV epidemic area of China.

METHODSInformation was collected and analyzed from 158 inpatients with AIDS related opportunistic infection, including demographic characteristics of patients, types of opportunistic infection and treatment cost (median) from 2008 to 2010 in a high HIV epidemic area.

RESULTSThe inpatient cost per visit for AIDS related opportunistic infection was 2935.7 yuan. The fee per visit for examination, laboratory test, medicine, diagnosis and treatment, nursing, bed was 132.5, 269.0, 1485.5, 367.3, 302.5 and 264.0 yuan, respectively. The inpatient cost per visit for AIDS related opportunistic infection was 4383.1 yuan for male and 3418.6 yuan for female inpatient (U = -1.279, P = 0.201). The cost per visit for AIDS related opportunistic infection was 4703.1 yuan for Han nationality and 3475.9 yuan for minority patient (U = -1.025, P = 0.305). The inpatient cost per visit for AIDS related opportunistic infection was respectively 3429.3, 5022.2, 6705.5 and 2396.7 yuan for farmers, individual businessmen, employees of enterprise and public institution and jobless (H = 28.633, P = 0.000). The cost per visit was lowest for illiteracy patients (2590.2 yuan), 3626.5 yuan for primary school, 4214.3 yuan for junior high school and 6865.8 yuan for high school and higher education (H = 10.828, P = 0.013). The cost per visit for AIDS related opportunistic infection was respectively 2873.6, 4534.3, 3077.8 and 3208.1 yuan for under the age of 29, 30-39 years old, 40-49 years old and beyond the age of 50 (H = 1.515, P = 0.679). The AIDS related opportunistic infection cost per visit for inpatients infected through sex (4621.3 yuan) was higher than that of intravenous drug users (3208.6 yuan, U = -2.588, P = 0.010). Among various types of opportunistic infections, the cost was highest for neurological diseases (5819.7 yuan), 4300.8, 2806.8, and 2083.9 yuan for respiratory diseases, digestive system diseases and skin and mucous membrane diseases, respectively (H = 15.142, P = 0.004).

CONCLUSIONThe study shows difference of inpatient cost per visit between subgroups, the cost of public institution was higher than that of other professions, the cost of illiteracy patients was lower than other education level, the cost of inpatients infected through sex was higher than that of intravenous drug users, the cost of neurological diseases was higher than that of other types of opportunistic infections.

AIDS-Related Opportunistic Infections ; economics ; Acquired Immunodeficiency Syndrome ; economics ; Adult ; Female ; Health Care Costs ; Hospitalization ; economics ; Humans ; Male ; Middle Aged

OBJECTIVETo investigate the application of the island flap based on the postfemur neurocutaneous nutrient vessel.

METHODSThe flap was designed and applied to repair the defects in the gluteal, popliteal fossa or the bilateral postfemur areas. A total of 11 cases (12 defects) were treated with this method. The size of the defects ranged from 4.0 cm x 7.8 cm to 8.3 cm x 16.6 cm.

RESULTSOf the 12 defects, 9 achieved complete success. Epidermal necrosis occurred in the distal part of the flap in 3 defects owing to venous stasis, which were cured with skin grafting. Postoperative follow-up for 8-19 months showed that the appearance, texture, and function of the flap were satisfactory.

CONCLUSIONSThe advantages of the flap lie in the reliable blood supply, constant anatomy, and without sacrificing a major artery. The key points for the flap survival are utilizing the "Superficial vein-nutrient vessel of the cutaneous nerve system" and retaining a comet tail-shaped soft-tissue pedicle in the flap creation.

Arteries ; Follow-Up Studies ; Humans ; Necrosis ; etiology ; surgery ; Skin ; injuries ; pathology ; Skin Transplantation ; Surgical Flaps ; blood supply ; pathology ; transplantation ; Thigh ; Wound Healing

OBJECTIVETo investigate the status quo of smoking cessation and analyze factors influencing smoking cessation in cigarette smoking patients with coronary artery disease (CAD).

METHODA total of 350 smoking patients with CAD was surveyed by questionnaire, logistic regression analysis was performed to analyze factors influencing smoking cessation.

RESULTSIncidence of smoking cessation was 57.1% (200/350) in this cohort. Patients were divided into two groups, the elderly (> 65 years old, n = 111) and the young group (≤ 65 years old, n = 239). The smoking cessation rate in the elderly group is significantly higher than in the young group (71.2% vs. 50.6%, P < 0.001). Aged patients and patients with high cultural level are easier to give up smoking. Logistic analysis showed that age ≤ 65 years old (OR = 2.336, P = 0.004), low cultural level (OR = 1.310, P = 0.028), PCI (OR = 0.261, P < 0.001), coronary artery bypass graft (OR = 0.107, P = 0.004), total family income > 4000 RMB/month (OR = 1.828, P = 0.003) are risk factors for failed smoking cessation. There are 76 patients smoking again in current smokers, most due to lack of self-control (76.3%). Compared to the elderly group, there is a higher proportion of smoking again due to the need of daily communication and work in the young group.

CONCLUSIONSWe still need to raise the awareness of smoking cessation for smoking patients with CAD. Following factors should be focused for tobacco control in CAD patients: younger age, lower cultural level, not treated with PCI or CABG, patients with smoking family members, higher body mass index and higher total family income.

Adult ; Aged ; Aged, 80 and over ; Coronary Artery Disease ; epidemiology ; prevention & control ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Smoking ; Smoking Cessation ; statistics & numerical data ; Surveys and Questionnaires

Objective To observe the protective mechanisms of zingiber officinalis extract on the lens of diabetic rats induced by streptozotocin (STZ).Methods Totally 60 SD rats were randomly divided into A group (normal control rats),B group (diabetic rats),C1 group (DM +50 mg · kg-1 ginger gavage),C2 group (DM + 100 mg ·kg-1 ginger gavage) and C3 group (DM + 300 mg · kg-1 ginger gavage).Each group had 12 rats.And rats in A group received intraperitoneal injection of the same volume of normal saline,while the other groups were intraperitoneally injected with 65 mg · kg-1streptozotocin (STZ).When the animal model was successfully established,both A group and B group were administered orally with normal saline,and the C1,C2 and C3 groups were administered orally with ginger rhizome extract.The changes in blood glucose and lens were observed every week.The rats were sacrificed in succession at 4 week,8 week,12 week,and the lens was removed immediately.The content of aldose reductase (AR) was detected by ELISA,and the expression of glycosylation end products (AGEs) was detected by Western blot.The superoxide dismutase (SOS) activity and malondialdehyde (MDA) content were also detected.Fluorescent Tunel staining was used to detect the apoptosis of the lens epithelial cells.And finally,scanning electron microscopy was used to observe the ultrastructural changes in the lens.Results The activity of SOD in the lens of diabetic rats showed a decreasing trend with statistical significance (all P ＜ 0.05).Changes in the content of MDA in the lens of rats in B,C1,C2 group were statistically significant in 4,8 and 12 weeks after successful modeling (all P ＜ 0.05),but no significant difference in A group and C3 group (both P ＞ 0.05).The persistent increase of AR in group B (P =0.003).The content of AR of the lens in C1,C2,C3 group showed a decreasing trend,and the differences were statistically significant (all P ＜ 0.05).There were significant differences in the expression of AGEs in C1,C2 and C3 group (all P ＜ 0.05).The degree of cortical fiber destruction in group B was progressively aggravated,but the degree of cortical destruction in C1,C2 and C3 group decreased with the increase of ginger gavage concentration through the scanning electron microscopy.It was observed that there was no significant difference in the apoptotic rate of LECs in A group (P =0.191),but the apoptosis of LECs in the rest group showed a rising trend,and the differences were statistically significant (all P ＜ 0.05).Conclusion The effects of ginger gavage extract can delay the opacification of lens and slow down the diabetic development in rats with a dose-independence manner.Ginger gavage extract may play a protective role on the lens of diabetic rats by inhibiting the activity of AR,oxidative stress and the production of AGEs as well as suppress the apoptosis of lens epithelial cells.

Objective To evaluate different hypertension management models in communities and their impact on incidence of cardio-cerebrovascular disease in hypertensive patients. Methods A total of 1 578 hypertension patients in several communities in Pudong New Area were recruited in the study ( August 2008 to December 2012 ) according to the inclusion criteria and randomly divided into two groups.The control group was given routine hypertension management and the study group was given detailed hypertension management, while health commissioners and community physicians were in charge of the follow-up and data collection. Results The incidence of cardio-cerebrovascular disease (1.33%) in study group (1.33%) was significantly lower than that of the control group (4.22%) ( P <0.05). Multivariate logistic regression analysis showed that age, male, course-of-disease, patients with hypertension family history, increase in SCr and LDL-C increased the risk for getting ardio-cerebrovascular disease (P <0.05).The risk of study group was 0.348 times the control group ( P <0.05). Conclusion Compared with control group, detailed hypertension management model conducted in study group has the advantages that effectively reduced the rate of cardio-cerebrovascular disease.

OBJECTIVETo explore the effects of trimetazidine therapy on left ventricular (LV) function after percutaneous coronary intervention (PCI).

METHODSA total of 106 patients with unstable angina pectoris underwent successful elective PCI were randomly assigned to standard therapy group (control, n = 55) or trimetazidine group (n = 51, 60 mg trimetazidine loading dose prior to PCI followed by 20 mg Tid after PCI on top of standard therapy). cTnI level was measured before and at 16-18 hours after PCI. LV function was evaluated by echocardiography and major adverse cardiac events (MACE, including death, re-infarction and target vessel revascularization) at 12 months after PCI was compared between the two groups.

RESULTSPost procedural cTnI level increased from [0.02 (0.01, 0.03)] µg/L at baseline to [0.11 (0.07, 0.13)] µg/L (P < 0.05) at 16-18 hours in the trimetazidine group, while [0.02(0.01, 0.03)] µg/L to [1.31(0.44, 2.31)] µg/L in the control group (P < 0.05). Post procedural cTnI level was significantly reduced in the trimetazidine group compared to the control group (P < 0.05). At 12 months follow-up, left ventricular ejection fraction in the trimetazidine group was significantly higher than in control group [(65.65 ± 3.94)% vs. (62.29 ± 3.06)%, P < 0.01] while incidence of MACE was similar between the two groups.

CONCLUSIONTrimetazidine can reduce the post-PCI cTnI release and improve left ventricular function after PCI in patients with unstable angina pectoris.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Postoperative Period ; Prospective Studies ; Trimetazidine ; therapeutic use ; Ventricular Function, Left ; drug effects

Objeetive To compare the thickness of corneal epithelium and full-thickness of the cornea among New Zealand rabbits,cats and the human using optical coherence tomography angiography (OCTA) technology as to explore the morphological basis for different animals as experimental models of xenocorneal transplantation.Methods Totally selected 12 New Zealand male rabbits and 12 male cats were included in this study and divided into group A and B.Then the thickness of corneal epithelium and full-thickness of the cornea of both eyes in the two groups were measured with OCTA technology,and according to the distance from the center of the cornea,the cornea was divided into 17 areas by System software.The center of the cornea was a diameter of 2 mm around the center of the cornea,with the inner ring and outer ring of 5 mm and 6 mm in diameter,respectively;and the inner and outer ring region was again divided into 8 areas,including superior side (S),superior nose side (SN),nasal side (N),inferior nose side (IN),inferior side (I),inferior temporal side (IT),temporal side (T),superior temporal side (ST).Then the thickness of corneal epithelium and full-thickness of the cornea in each region were measured for comparing the difference of New Zealand rabbits' and cats' corneal thickness with the human's.Results The thickness of corneal epithelium and full-thickness of the cornea of cats were both thicker than those of rabbits.The full-thickness of the cats' cornea became thinner from the central to the peripheral side,and the difference of thickness between the T5,ST5,S5,SN5,N5 areas and the central of the cornea was statistically significant (all P ＜0.05);the thickness of corneal epithelium in the ST5,S5,SN5 areas was significantly thicker than the central area (all P ＜0.05);And this was true of the rabbits' full-thickness of the cornea,and the difference in the full-thickness of the cornea between the T5,IT5,IN5,N5,T6,N6 area and the central region was statistically significant (all P ＜ 0.05);meanwhile there were also significant difference in the thickness of corneal epithelium between the ST5,S5,SN5,ST6,S6,SN6 areas and the central area (all P ＜ 0.05).Additionally,there were significant differences in the thickness of corneal epithelium and full-thickness of the cornea between the two experimental animals and humans (all P ＜ 0.05).Conclusion The cornea of cats possesses similar regions in corneal full-thickness and epithelial thickness as well as the distribution to human cornea,so cats have superiority to the rabbits for the potential donor of xenocorneal transplantation in human beings.

Objective: To investigate the current status of antithrombotic strategy for elderly patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) after stent implantation in Beijing area and to study the safety and efficacy of different therapeutic strategy. Methods: A total of 467 relevant patients were enrolled by re-travelling electronic medical records from 12 hospitals in Beijing area. The patients' mean age was (78.70±3.32) years and they were divided into 2 groups by antithrombotic therapy condition: Triple therapy group, n=17 (3.64％), Double therapy group, n=450 (96.36％). The incidence of major adverse cardiac and cerebral events (MACCE) including all-caused death, non-fatal myocardial infarction, stent thrombosis, target vessel revascularization (TVR), stoke and bleeding was compared between Triple therapy group and Double therapy group.Results: The medication in Double therapy group included aspirin+ticagrelor, aspirin+clopidogrel, clopidogrel+warfarin and cilostazol+clopidogrel; in Triple therapy group was aspirin+clopidogrel+warfarin. Patient with HAS-BLED score≥3 was defined as high risk of bleeding and they were all treated by double therapy; HAS-BLED<3 was defined as low risk of bleeding, only 5.03％ patients were treated by triple therapy. 3 patients in Triple therapy group and 33 in Double therapy group suffered from gastrointestinal bleeding, P=0.338; 6 patients in Triple therapy group and 128 in Double therapy group had MACCE, P=0.589; 3 and 80 patients died in Triple therapy group and Double therapy group, P=0.766. Conclusion: Triple therapy was rarely used in elderly AF and ACS patients after stent implantation, double therapy was the main strategy; the incidence of MACCE and mortality were similar between triple and double therapies; patients with triple therapy had the higher incidence of gastrointestinal bleeding.