Objective To evaluate the clinical value of electron beam computed tomography (EBCT)in the diagnosis of atherosclerotic aortic ulcer.Methods Sixty-eight consecutive patients(55 men and 13 women,aged 40—85 years,mean 65.12?9.55 years)with atherosclerotic aortic ulcer,who underwent EBCT scans from December 2001 to December 2004,were studied retrospectively.Contrast- enhanced continuous volume scanning(CVS)was performed by Imatron C-150XP EBCT scanner with 6 mm or 3 mm slice thickness and 100 milliseconds acquisition time.The scan was started 18—30 s after the injection of 80—100 ml contrast medium at the rate of 3.5—4.5 ml/s.Results In sixty-eight patients with atherosclerotie aortic ulcer,50 patients had acute aortic syndromes,36 had intramural hematomas,15 had atherosclerotic aortic aneurysms,3 had aortic dissections.46 patients with progresive ulcer usually had acute aortic syndrome while 22 patients with stable ulcer didn't(P

Objective　To explore the risk factors and causes affecting the operative mortality in esophagectomy patients with esophageal can cer. Methods　1400 cases with a curative esophagectomy for neopl asm of esophagus hospitalized from Mar,1973 to June, 2000 were reviewed. There w ere 31 died within 30 d or during hospitalization after esophagectomy as a group , and 1 369 survival cases, after operation, as another group. Sixteen factors t hat may influence the operational mortality were selected. A multi-variate anal ysis of these individual variables was performed by the computer′s logistic reg ression model. Results　The operative mortality was 2.2%(31/1400 ). The causes of death included respiratory complication 17 cases (including res piratory failure caused by pneumonia or atelectasis), 15 cases, and adult respir atory distress syndrome (ARDS) 2 cases, the mortality was 54.8% in the death gro up), anastomotic leak 11 cases (34.5%), Chylothorax 2 cases (6.5%) and postopera tive digestive tract hemorrhage 1 case (3.2%). The results showed that the major risk factors that affected operative mortality in cases with esophageal cancer were history of long-herm heavy smoking, duration of operation and the year of operational (P<0.05). Conclusion　To minimize operative mort ality of esophagectomy, some means must be noticed, including the reinforcemen t of the perioperative care, the improvement of anastomotic methods and surgical skill, reduing operative time as p ossible, disposing pulmonary complications in time and using respirator if neces sary.

BACKGROUND:The intestine is not only the main target attacked by sepsis but also the vital organ which mediated sepsis. The recovery of the damaged intestinal barrier structure and function is related to the occurrence and outcome of multiple organ dysfunction syndrome (MODS). How to protect and reduce the damage of the intestinal mucosa and how to promote the reconstruction of the intestinal mucosa have been the important topics in sepsis for many years. This study aimed to investigate the influential factors of intestinal mucosal reconstruction after intestinal epithelial injuryin vivo in a mouse model of sepsis.METHODS:Mice were subjected to cecal ligation and puncture (CLP) for induction of sepsis to assess intestinal mucosal damage, epithelial cell apoptosis, and transformed number of goblet cells, and to detect the concentration of TNF-α, IL-1 and TGF-β1 and TFF3 (trefoil factor 3) expression in the small intestinal mucosa. All above were performed by HE staining, western blot, ELISA and immunohistochemistry respectively. The experimental animals were divided into a sepsis group and a sham-operation group. The animals with sepsis were separately killed at 6 (7 animals), 24 (7 animals) and 48 hours (7 animals) after CLP.RESULTS:Injured intestinal mucosa was observed in the 3 groups under a light microscope, in which damage scores in the 24-hour and 48-hour groups were higher than in the 6-hour group and no difference was found between the two groups. Moreover, less of goblet cells or other epithelial cells adjacent to the injured surface migrated into the wound to cover the denuded area. The number of goblet cells was substantially decreased in the three CLP groups compared with the sham-operation group. Protein levels of IL-1 and TNF-α were significantly increased by 3-4 fold at all time points when compared with the sham-operation group, and cleaved caspase-3 by 4 fold. Although TFF3 expression was modestly increased for 6 hours after the onset of CLP, it appeared to decline at 24 hours and 48 hours as shown by Western blot. A similar tendency was observed upon TGF-β1, i.e. the protein level was not elevated at 24 hours and 48 hours, but increased modestly at 6 hours.CONCLUSIONS:Sepsis from CLP shows less restitution on the surface of injured intestinal mucosa. There is evidence that both constant inflammatory reaction and epithelial cell apoptosis may affect mucosal reestablishment of the intestine at the onset of sepsis. Mucosa after severe sepsis showed the state of high inflammation, and declined goblet cell function and mucosal reconstruction, which affected the repair of damaged intestinal barrier. Constant inflammatory reaction, and declined goblet cell function and mucosal reconstruction ability may affect the reestablishment of intestinal mucosa at the onset of sepsis.

Objective To test the possibility of reciprocal pathways between medullary visceral zone (MVZ) and hypothalamic paraventricular nucleus (PVN) or supraoptic nucleus (SON) following hyperosmotic stimulation. Methods Hyperosmotic pressure animal model was established by administering3% sodium chloride as drinking water to rats. The distributions and expressions ofHRP retrogradely labeled neurons, Fos, tyrosine hydroxylase (TH) or vasopressin (VP) positive neuron and lial fibrillary acidic protein (GFAP) positive astrocytes (AST) in MVZ, SON and PVN were observed by quadruple labeling methods of WGA-HRP retrograde tracing combined with anti-Fos, TH (or VP) and GFAP immunohistochemical technique. Results Fos positive neurons within the MVZ, PVN and SON increased markedly. There were also a large number of GFAP positive structures in the brain and their distribution pattern was fundamentally similar or analogous to Fos positive neurons in the above-mentioned areas. The augmented GFAP reactivities took on hypertrophic cell bodies, thicker and longer processes.Quadruplicate immunohistochemical staining showed that a neuron could be closely surrounded by many AST and they formed neuron-astrocytic complex (N-ASC). Conclusion The neurons and AST might be very active following hyperosmotic pressure and N-ASC as a functional unit might serve to modulate the osmotic pressure. There was reciprocal osmoregulation pathways between the MVZ and SON or PVN in the brain.

To study relevant risk factors of Shenmai injection induced adverse reactions by using Logistic model and ROC curve, and made the prediction for the occurrence of relevant adverse reactions/events. Case data of patients treated with Shenmai injection were collected by using the prospective, multi-center, large-sample, nested-case control method, in order to analyze the risk factors of Shenmai injection-induced adverse reactions/events, establish the logistic model and draw the receiver operating characteristic (ROC) curve for risk factors. During the study, 7632 patients (including 3 477 males and 4 155 females) were included, and eight of them suffered adverse reactions/events. Based on a multi-factor Logistic model analysis, the age (> or = 50 years) (OR = 5.061, 95% CI: 2.197-7.924; P = 0.001), the total number of medication days (OR = -1.020, 95% CI: -l.652 - 0.388; P = 0.002) and the single dose (OR = 0.245, 95% CI: 0.127-0.364; P = 0.000) were significant independent risk factors for Shenmai injection-induced adverse reactions/events. According to the results, ROC curves were drawn with age (> or = 50 years), the total number of days of inedication and single dose; The area under ROC curves the joint predictor (0.9753, 95% CI: 0.9443-1.000, P < 0.005) was larger than that of the other three single indexes, with a higher risk prediction value. The independent risk factors for Shenmai injection-induced adverse reactions/events included the age (> or = 50 years), the total number of days of medication and single dose. In clinical practice, the age (> or = 50 years), the total number of days of medication and the medication dose can be substituted in the joint predictor calculation formula (P = 1 / [1 + e(-(-21.58 + 5.061 x Xage - 1.020 x Xd + 0.245 x X(mL)] to predict the potential adverse reactions of patients and adjust the dosage regimen.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; China ; epidemiology ; Drug-Related Side Effects and Adverse Reactions ; epidemiology ; etiology ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; Female ; Humans ; Infant ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; ROC Curve ; Risk Factors ; Young Adult

OBJECTIVERett syndrome (RTT) is an X-linked progressive neurodeveopmental disorder that almost exclusively affects girls, and is one of the most common causes of mental retardation in females, with an estimated prevalence of approximately 1 in 10,000 - 15,000 female individuals. Mutations in X-linked methyl-CpG-binding protein 2 (MECP2) gene, located on chromosome Xq28, have been found to be a cause of RS. A lot of mutations have been reported to be related to RS recently. Mutations are found in 70% - 85% of patients with classical RTT and in less than 50% of patients with atypical RS. Up to now, RTT is diagnosed based on a consistent counseling for clinical features and the established diagnostic criteria. The present study aimed to investigate frequency and type of mutation of MECP2 gene and if hot spot of mutation exits in patients with atypical RTT and find out the relationship between genotype and phenotype.

METHODSA systematic analysis of the entire coding region of MECP2 in 26 unrelated patients with atypical RTT was performed by polymerase chain reaction (PCR) and direct sequencing. Genomic DNA was extracted using standard procedures from the peripheral blood leukocytes of each patient. PCR amplification products were checked by 2% agarose gel electrophoresis and were subsequently sequenced with ABI 3730 Automated DNA Sequencer with both the forward and reverse primers. Mutational analyses were performed using normal human genomic MECP2 sequence as a reference (GenBank accession NO.AF030876).

RESULTSSeven mutations were identified in 12 of 26 patients. Most of the mutations were missense mutation; c.397C > T (R133C) was found in 3 of 26 patients; c.473C > T (T158M) and c.916C > T (R306C) were found in 2 of 26 patients, respectively; c.397A > G (R133H) and c.1005G > A (R335C) were found in 1 of 26 patients, respectively. One base pair deletion mutation (806delG) resulting in frameshift was found in 2 of 26 patients, and 1 base pair transversion at splice accept-site (IVS3-2A > T).

CONCLUSIONThe results of this study indicated that c.397C > T (R133C), c.473C > T (T158M) and c.916C > T (R306C) were hot spot mutations in MECP2 gene of patients with atypical RTT. There was some relationship between genotype and phenotype.

Base Sequence ; Child ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Humans ; Methyl-CpG-Binding Protein 2 ; genetics ; Molecular Sequence Data ; Mutation ; Mutation, Missense ; Phenotype ; Polymerase Chain Reaction ; Rett Syndrome ; genetics ; Sequence Analysis, DNA

OBJECTIVETo observe whether the community-based management for patients with hypertension can reduce the incidence of stroke.

METHODSSample of this study included 36 863 people aged 35 years or more who came from a cohort consisting three communities from Tiantan Hospital, Puren Hospital and the Gymnasium Road Hospital in Beijing, based on the surveys on the Integrated Community Intervention Measures of Cerebro-vascular Diseases. Some patients with hypertension in this cohort were followed up and under management. First-ever stroke was considered as the end-point event.

RESULTSIn both groups diagnosed as borderline hypertension or definite hypertension group, the rates of management and control showed an annual increase. The management rate for women was higher, but the control rate was lower (P < 0.05) than that for men. In the third year of this study, the control rate was nearly 18%. With the qualification of control rate, the risk factors of overall stroke, ischemic stroke or hemorrhagic stroke reduced gradually, and the qualification of control rate showed more effects on hemorrhagic stroke. The qualification of control rate in the three years could cause the risk factors of total stroke, ischemic stroke or hemorrhagic stroke to reduce by 25.7%, 19.1%, 27.4%, respectively. When comparing with blood pressure level at < 160/95 mm Hg (1 mm Hg = 0.133 kPa), the level of < 140/90 mm Hg could reduce the risk factors as: 12.3% to total stroke, 12.8% to ischemic stroke and 14.9% to hemorrhagic stroke.

CONCLUSIONPrograms as long-term followed-up and management for patients with hypertension, and control the blood pressure at low level etc. could significantly reduce the incidence of stroke.

Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; Female ; Humans ; Hypertension ; complications ; epidemiology ; Male ; Middle Aged ; Stroke ; epidemiology ; etiology

OBJECTIVETo explore the risk factors and prevention strategies of post-operative complications in elderly patients with colorectal cancer.

METHODSData of 107 elderly patients (≥75 years) undergoing surgery for colorectal cancer were collected from January 2006 to December 2009 in the Department of Gastrointestinal Surgery, Peking University People's Hospital. POSSUM and E-POSSUM scoring systems were used to predict post-operative complications. ROC curve and observe/expect(O/E) were used to assess the validity of scoring systems. Logistic regression was used to evaluate the independent risk factors associated with post-operative complications of elderly patients with colorectal cancer.

RESULTSThe predictive complication rates of E-POSSUM and POSSUM in elderly patients with colorectal cancer were 13.9%-86.6%(average, 32.7%) and 19.1%-99.1% (average, 55.5%). The predictive validity of E-POSSUM was better than POSSUM(AUC of ROC: 0.862 vs. 0.576, O/E: 0.771 vs. 0.454), the former was closer to the actual complication rate(25.2%, 27/107). Concurrent diabetes mellitus(P=0.019) and rectal lesion(P=0.005) were independent risk factors associated with surgery-related post-operative complications. Anastomotic leakage was the most common surgery-related post-operative complications. Chronic obstructive pulmonary disease(P=0.026), ASA score(P=0.025), intestinal obstruction(P=0.037) and perforation(P=0.001) were independent risk factors associated with non-surgery-related post-operative complications. Pulmonary infection was the most common non-surgery-related post-operative complication.

CONCLUSIONSThe application of E-POSSUM scoring system can provide more accurate prediction of post-operative complications in elderly patients undergoing surgery for colorectal cancer. Positive interventions should be taken for high-risk patients to prevent post-operative complications.

Aged ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Male ; Postoperative Complications ; etiology ; prevention & control ; Risk Factors

In order to construct RGD-mSAK mutant with reduced immunogenicity, and identify its biological activity after purification, mSAK gene fragment was amplified by over-lapping extension PCR. Then the gene was inserted into the prokaryotic expression vector pBV220 with P(R)P(L) promoters after confirmed by DNA sequencing; the expression plasmid pBV220-RGD-mSAK was constructed, and then was transformed into E. coli. DH5alpha. After temperature induction, the mutant Staphylokinase was over-expressed and much of protein was in the supernate of lysate, which is over 50% of total protein in the host. The protein was isolated and purified in Q-Sepharose FF, Sephacryl S-200 and SP, high purity protein was obtained and its purity was over 98%. The thrombolysis activity of the RGD-mSAK protein is 1.68 x 10(5) u/mg by fibrin plate assay, which is slightly higher than that of the wild-type, and antiserum titers raised against this protein in guinea pigs were much lower than those of wild-type SAK, determined by ELISA. In anti-platelets aggregation assay in vitro, the RGD-mSAK protein has obvious inhibition activity of platelet aggregation in low concentration comparing to the control group and wild-type SAK group. So the RGD-mSAK protein is a low immunogenicity, bi-function molecular with both thrombolysis activity and anti-embolism activity. It provided the basis for further research of RGD-SAK.
Animals ; Base Sequence ; Escherichia coli ; genetics ; metabolism ; Guinea Pigs ; Metalloendopeptidases ; biosynthesis ; metabolism ; Molecular Sequence Data ; Mutant Proteins ; biosynthesis ; genetics ; Oligopeptides ; metabolism ; Platelet Aggregation ; drug effects ; Platelet Aggregation Inhibitors ; pharmacology ; Protein Engineering ; Recombinant Proteins ; biosynthesis ; genetics ; isolation & purification

OBJECTIVETo observe the effects of temporary acid exposure on cell proliferation and extracellular signal-regulated protein kinase (ERK) activity in normal human esophageal epithelial cells in vitro.

METHODSNormal human esophageal epithelial cells cultured in vitro were exposed to acidic media (pH 4.0-6.5) for 3 to 60 min, and the control cells were cultured at pH 7.3. MTT assay and flow cytometry were employed for cell proliferation assessment. The expression of phosphorylated ERK1/2 protein was determined by immunoblotting.

RESULTSEsophageal epithelial cells with acid exposure for 3 min exhibited a significant increase in cell proliferation, increased number of cells in S phase and enhanced expression of phosphorylated ERK1/2 protein. Acid exposure of the esophageal epithelial cells exceeding 6 min resulted in depressed proliferation and decreased S-phase cells, and cell proliferation induced by acid exposure was abolished by pretreatment with U0126.

CONCLUSIONTemporary acid stimulus increases cell proliferation of normal human esophageal epithelial cells in vitro by activating the ERK pathway.

Acids ; pharmacology ; Blotting, Western ; Butadienes ; pharmacology ; Cell Proliferation ; drug effects ; Cells, Cultured ; Culture Media ; pharmacology ; Enzyme Inhibitors ; pharmacology ; Epithelial Cells ; cytology ; drug effects ; metabolism ; Esophagus ; cytology ; Extracellular Signal-Regulated MAP Kinases ; antagonists & inhibitors ; metabolism ; Humans ; Hydrogen-Ion Concentration ; Immunohistochemistry ; Keratin-14 ; analysis ; Nitriles ; pharmacology ; Signal Transduction ; drug effects ; Time Factors