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Objective: To evaluate the correlation between the length of first metatarsal, hallux valgus angle (HVA), intermetatarsal 1-2 angle (IMA1-2), plantar appearance, sesamoid position and postoperative 2-5 transfer metatarsalgia., Methods: Retrospective analysis was performed for the clinical data of 375 cases (626 feet) undergoing osteotomy of first metatarsal with mini-incision. All cases were examined radiographically via weight-bearing and lateral views. HVA, IMA1-2 and the length of first metatarsal were measured preoperatively and postoperatively. Forefoot plantar pressure was measured during walking by Foot scan system preoperatively and postoperatively., Results: After a mean follow-up period of 12-30 (18.5 ± 6.8) months, all patients had satisfactory bone healing without late healing or disunion. There were superficial wound infection (n = 1, 1 foot) and suture reaction (n = 1, 1 foot). HVA was 7.18° ± 4.55° postoperatively and corrected by 30.54°; IMA1-2 5.07° ± 1.70° and corrected by 12.33°. The number of shorting of first metatarsal during 0-2 mm was 424 feet, there was 1 case of transfer metatarsalgia at rays 4; the number during 2-4 mm was 186 feet, there were 5 cases of transfer metatarsalgia at rays 2. The center of pressure shifted laterally; the number during 2-4 mm was 16 feet, there were 4 cases of transfer metatarsalgia at rays 2 and 3. The center of pressure shifted evidently medially; the shorting of first metatarsal was 4.8 ± 0.46 mm. A negative correlation was found between length of metatarsal and transfer metatarsalgia at rays 2 and 3. No correlation existed between transfer metatarsalgia at rays 2 and 5, HVA and IMA1-2. A positive correlation existed between HVA decrease and patient satisfaction with their postoperative foot alignment. There was no correlation between lengthening of metatarsal and IMA1-2 decrease., Conclusion: Length preservation of first metatarsal seems to prevent the postoperative transfer metatarsalgia on second and third rays. The shorting of first metatarsal should be no more than 2 mm.

Objective: To set up a prediction rule for the pro-operative differential diagnosis of thyroid nodules and evaluate its clinical value., Methods: All patients of thyroid nodules underwent thyroid operations in Changzheng hospital from June, 1997 to July, 2012 were included in this study. They were randomly divided into the derivation cohort (2/3) and the validation cohort (1/3). A prediction rule was developed based on the logistic regression model and the scoring system was established in accordance with assigning of the value of each variable β in the model. The prediction consistency, discriminatory power and diagnostic accuracy were conducted to evaluate the clinical value of the scoring system., Results: A total of 13 980 patients were enrolled in the study with 9195 in the derivation cohort and 4785 in the validation cohort. The prediction rule consisted of 18 variables, which were gender, clinical manifestations including fever, neck sore, neck mass, palpitation and sweating, serum level of thyroid stimulating hormone (TSH) , free triiodothyronine (FT3) , thyroid peroxidase antibody (TPOAb) , thyroglobulin antibody (TgAb) , thyroglobulin (Tg) , calcitonin and carcinoembryonic antigen (CEA) , ultrasonography features including nodules number, location, size, boundaries and ethological patterns and the presence and patterns of lymph nodes. The model showed good calibration consistency (P = 0.437) and discrimination power (area under the receiver operating characteristic curve was 0.928) in the derivation cohort. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of the model were 89.3%, 81.5%, 83.2%, 56.8%, 96.6%, 4.83 and 0.13, respectively., Conclusion: The prediction rule and its scoring system established in the study are efficacious for the calibration and discrimination of thyroid nodules in Chinese population, which could be a useful tool for the pro-operative risk stratification.

Objective: To examine the trend in meat consumption patterns between 1991 and 2011 in Chinese children in nine provinces(autonomous region) aged 6 to 17 years., Methods: A multistage, random cluster sampling process was used to investigate 2720, 2702, 2525, 2405, 1509, 1238, 1085, and 936 children and adolescents aged 6-17 years in 1991, 1993, 1997, 2000, 2004, 2006, 2009 and 2011 respectively in 9 provinces (autonomous region) in China. Their consecutive 3 d 24 h dietary recall data were analyzed to compare meat intake pattern in children and adolescents with different characteristics and different years., Results: The consumption rate increased from 60.9% (1657/2720) in 1991 to 87.2% (816/936) in 2011 for livestock meat (χ(2) = 458.23, P < 0.01), from 9.4% (257/2720) to 33.3% (312/936) for poultry (χ(2) = 446.07, P < 0.01) and from 27.3% (743/2720) to 40.6% (380/936) for seafood (χ(2) = 89.89, P < 0.01). The median of total meat intake increased from 47.4 g/d in 1991 to 100.0 g/d in 2011 (χ(2) = 516.77, P < 0.01), poultry intake from 33.3 g/d to 60.0 g/d (χ(2) = 420.13, P < 0.01), pork intake from 26.7 g/d to 50.0 g/d (χ(2) = 380.50, P < 0.01). The percentage of children whose livestock meat and poultry intakes higher than the recommended amount increased from 32.9% (896/2720) in 1991 to 59.8% (560/936) in 2011 (χ(2) = 392.97, P < 0.01); the percentage of children whose seafood intakes meeting the recommended amount increased from 6.9% (187/2720) in 1991 to 8.8% (82/936) in 2011 (χ(2) = 21.52, P < 0.01). The consumption rates of livestock meat in urban and rural children increased from 81.2% (536/660) and 54.4% (1121/2060) in 1991 to 94.7% (234/247) (χ(2) = 38.34, P < 0.01) and 84.5% (582/689) (χ(2) = 429.26, P < 0.01) in 2011. The intakes of livestock meat in rural children increased from 16.7 g/d in 1991 to 56.7 g/d in 2011 (χ(2) = 472.46, P < 0.01)., Conclusion: The overall pattern of meat consumption in Chinese children in nine provinces(autonomous region) was unreasonable between 1991 and 2011. There was a significant improvement in meat consumption in rural children over time.

Objective: To observe the dynamic levels of serum Golgi protein 73(GP73) in patients prior to and after the onset of liver cancer, and to explore the related factors., Methods: From 2007 to 2012, a periodical screening program was carried out in a group of high risk population with positive Hepatitis B surface antigens (HBsAg) , twice a year. Their serum specimens from every screening time point were kept in Qidong Biobank until liver cancer was diagnosed. Thirty-nine patients with liver cancer were recruited for the study, each of them at least had three times of specimens collected as well as B ultrasound scan (BUS) exam results at onset of disease and within 30 months before diagnosed, amongst 6 time points. In total, there were 162 specimens collected to test GP73 by double-antibody sandwich enzyme-linked immuno-sorbent assay (ELISA). Statistical analyses of time series and differences among groups were performed by stata software 10., Results: The average value of 39 patient's GP73 at the time point of liver cancer onset was (126.77 ± 73.73) µg/L, while the values at the other five time points prior to the onset were (128.32 ± 81.18) , (129.97 ± 83.62) , (127.38 ± 80.10) , (135.52 ± 97.88) and (138.24 ± 93.58) µg/L, respectively, with no significant difference (F = 0.07, P = 0.997). No obvious changing trends of GP73 were observed among the 39 liver cancer cases at the 6 time points. All 162 samples were divided into two groups: without hepatic cirrhosis (63 samples) and with cirrhosis (99 samples) according to findings of B-ultrasonic wave; whose average GP73 values were separately (97.16 ± 51.39) and (151.20 ± 91.68) µg/L. The difference showed statistical significance (F = 18.22, P < 0.01). Furthermore, if we grouped the samples by the average value of GP73 at 130.19 µg/L, then there were only 1/14 of the subjects without hepatic cirrhosis having higher GP73 values, but 12 of the 25 subjects with hepatic cirrhosis having higher GP73 values. The difference showed statistical significance (P = 0.013). The results of Linear regression model also showed that there was no correlation between GP73 and time series (t = 0.75, P = 0.455), but significant correlation between GP73 and hepatic cirrhosis (t = 4.30, P < 0.01)., Conclusion: No significant changes of the dynamic levels of GP73 could be found among the liver cancer patients within 30 months prior to the onset of disease. GP73 values of the patients with liver cancer may depend on their background of hepatic diseases; and hepatic cirrhosis might be one of the main influencing factors or confounding factors.

Objective: To evaluate the diagnostic value of external anal sphincter electromyography (EAS-EMG) versus urethral sphincter electromyography (US-EMG) in patients with multiple system atrophy (MSA)., Methods: A total of 27 MSA patients were examined with EAS and US-EMG as treatment group while 28 non-MSA subjects as control group. Spontaneous activities during relaxation, mean duration & amplitude of motor unit potential (MUP), percentage of polyphasic and variations during strong contraction were recorded and analyzed statistically., Results: There was significant difference in light contraction between MSA and non-MSA cases on both EAS-EMG and US-EMG (EAS-EMG, P < 0.001; US-EMG, P = 0.002) . Meanwhile, strong contraction and percentage of polyphasic showed significant differences between MSA and non-MSA cases on EAS-EMG only (strong contraction, P = 0.016; percentage of polyphasic, P = 0.004) . EAS-EMG showed more significant changes in neurogenic injury than US-EMG., Conclusions: US-EMG and EAS-EMG are valuable for the diagnosis of MSA. The differences of multiple parameters of EAS-EMG were more significant than those of US-EMG for MSA cases. US-EMG may serve as a supplement of EAS-EMG in case of restriction.

Objective: To explore the cognitive function, emotional status and activities of daily living in patients with multiple system atrophy (MSA)., Methods: Thirty-two MSA patients and 38 healthy controls from October 2009 to November 2012 were recruited from our hospital. Their cognitive function, emotional status and activities of daily living were assessed. Cognitive function was assessed by Montreal cognitive assessment (MoCA) and mini-mental state examination (MMSE); emotional status by self-rating depression scale (SDS) and self-rating anxiety scale (SAS); daily living and activities by activities of daily living scale (ADL). Data analysis was performed with SPSS 19.0. And the results were presented as the mean ± standard deviation. Comparison of means was performed with independent sample t test. And Pearson's correlation test was used for correlation analysis. A P-value <0.05 was considered significant., Results: Mild or moderate cognitive impairment was documented in 71.9% of MSA patients. The scores of MoCA and MMSE in the MSA group were significantly lower than those in the control group. And the scores of ADL, SDS and SAS in the MSA group were significantly higher than those in the control group (P < 0.05). MoCA subitems such as space/executive function, attention, abstraction, language and delayed memory of the MSA group were significantly lower than those of the control group (P < 0.05). A negative correlation existed between the scores of MoCA and MMSE with disease duration (P < 0.01). There was a positive correlation between the scores of SDS and SAS with ADL and disease duration (P < 0.05). And the relationship was significant between the scores of SDS and SAS (P < 0.01). A positive correlation existed between scores of ADL with disease duration (P < 0.05)., Conclusion: MSA patients have certain degrees of cognitive impairment, emotion disorders and impaired ADL. Cognitive impairment in MSA patients may be more common than previously. Furthermore, the clinical features of cognitive impairment in these patients may have some clinical values for references.

Objective: To explore the disease course and outcomes of severe or critical pregnant women with 2009 pandemic H1N1 (pH1N1) infection in China., Methods: A retrospective observational study was conducted for 394 severe or critical pregnant women with pH1N1 influenza admitted into hospital in 27 Chinese provinces from September 1, 2009 to December 31, 2009. Their clinical features in different trimesters were analyzed. The viral infection of pH1N1 was verified by real-time reverse transcription (rRT)-PCR. Severe and critical cases were defined according to the 2009 H1N1 clinical guidelines., Results: Among them, 374 (94.9%) were infected in the second or third trimester. Fever and cough were the most common symptoms in all trimesters. However, hemoptysis, dyspnea and associated pneumonia were likely to occur in the second or third trimester. The ratio of required mechanical ventilation in the second or third trimester (44.7%, 167/374) was significantly higher than that in the first trimester (3/20). Among 77 mortality cases, 72.7% (56/77) died in the third trimester. Pregnancy was terminated after the onset of pH1N1 symptoms in 52.5%(207/394) pregnant women. And 57.0%(118/207) of them had delivery < 37 weeks and 29.0%(60/207) fetuses deceased., Conclusion: A clinician should be on a high alert for pH1N1 infection in pregnant women, particularly in the second or third trimester.

Objective: To explore the exercise characteristics of patients with idiopathic pulmonary arterial hypertension (IPAH)., Methods: From November 2010 to September 2012 , 76 consecutive IPAH patients and 24 healthy controls from Fuwai Cardiovascular Hospital were enrolled to undergo cardiopulmonary exercise testing. The exercise parameters were compared. Correlations among peak oxygen consumption, anaerobic threshold, peak oxygen pulse, New York Heart Association (NYHA) class, N-terminal pro-brain natriuretic peptide (NT-proBNP), 6-minute walking distance (6 MWD) and cardiac index are analyzed in IPAH., Results: There were 21 males and 55 females in IPAH and 8 males and 16 females in controls. Their mean ages were (31.5 ± 10.6) and (35.5 ± 6.4) years respectively. Significant differences (P = 0.000) existed between two groups in peak oxygen consumption ((12.7 ± 3.3) vs (25.6 ± 5.8) ml·min(-1)·kg(-1)), anaerobic threshold ((9.8 ± 2.5) vs (16.7 ± 3.9) ml·min(-1)·kg(-1)), peak oxygen pulse ((5.3 ± 1.6) vs (9.9 ± 2.5) ml/bpm) and ventilator efficiency (slope of minute ventilation in relation to CO2 produced) ((42.6 ± 2.0) vs (25.5 ± 3.5)). In IPAH, peak oxygen consumption was significantly correlated with NYHA class (r = -0.509, P = 0.000), 6 MWD (r = 0.443, P = 0.002) and NT-proBNP levels (r = -0.423, P = 0.011). And anaerobic threshold was significantly correlated with NYHA class (r = -0.362, P = 0.002), 6MWD (r = 0.343, P = 0.004) and NT-proBNP levels (r = -0.275, P = 0.017). Peak oxygen pulse and ventilator efficiency were both correlated well with total pulmonary vascular resistance. Partial correlation analysis demonstrated that there were significant correlations among peak oxygen consumption, anaerobic threshold, NYHA class, NT-proBNP levels and 6MWD after adjusting for age, gender and weight., Conclusions: Peak oxygen consumption and anaerobic threshold decrease ventilator efficiency in IPAH patients. Cardiopulmonary exercise testing is an invasive tool of assessing safely the function of IPAH patients.

Objective: To explore the clinical features and hemodynamics of adult patients with Eisenmenger syndrome in different types of congenital heart diseases (CHD)., Methods: Patients with Eisenmenger syndrome with different types of CHD diagnosed by right heart catheterization were enrolled from 31 clinical centers in China during the period from May 2007 to October 2010. Age, gender, body mass index (BMI), symptoms and signs, World Health Organization functional class (WHO-FC) of pulmonary hypertension, six-minute walk distance (6MWD) and hemodynamics were recorded. All the above indices were analyzed and compared., Results: A total of 224 patients with Eisenmenger syndrome with 3 kinds of CHD were enrolled, including atrial septal defect (n = 67), ventricular septal defect (n = 104) and patent ductus arteriosus (n = 53). Among them, there were 67 males (29.9%) and 157 females (70.1%) with a mean age of (29.6 ± 9.9) years (range: 15-63). Mean BMI was (19.9 ± 4.0) kg/m(2) and mean 6MWD (371 ± 75) m. The majority of patients were in WHO-FC II (n = 158, 70.5%) and III (n = 64, 28.6%). Electrocardiogram of 77.2% of them indicated hypertrophic right ventricle. Mean right atrial pressure was (8.9 ± 5.7) mm Hg (1 mm Hg = 0.133 kPa), mean pulmonary arterial pressure (mPAP) (77.2 ± 19.1) mm Hg, cardiac index (3.03 ± 1.35) L·min(-1) · m(-2) and pulmonary vascular resistance (PVR) (1621 ± 887) dyn · s · cm(-5)., Conclusions: The majority of patients with Eisenmenger syndrome with different types of CHD are young females and ventricular septal defect is the most frequent underlying cause. The deterioration of heart function in patients with Eisenmenger syndrome is non-parallel to mPAP and PVR in CHD.

Objective: Pedicle subtraction osteotomy (PSO) is a spinal realignment technique of correcting the sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal correction. However, the quantitative effect of PSO level and focal angular change on postoperative spino-pelvic parameters has not been fully elucidated. The purpose of this study was to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spino-pelvic parameters., Methods: Retrospective analysis was conducted for 34 patients undergoing PSO surgery for ankylosing spondylitis. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar lordosis, thoracic kyphosis), pelvic parameters of pelvic tilt (PT), pelvic incidence (PI) and sacral slope (SS) and global balance of sagittal vertical axis (SVA). And the correlations between PSO parameters (level and degree) and spino-pelvic parameters were analyzed., Results: There were significant changes in spino-pelvic parameters including decreased thoracic kyphosis, increased lumbar lordosis, decreased SVA, decreased PT and increased SS. The decreased SVA were 3.94 ± 3.38 and 3.97 ± 1.91 in lumbar/thoracic osteotomy respectively (P > 0.05). The decreased values of PT were 9.71 ± 6.46 and 5.20 ± 2.74 respectively (P < 0.05). Larger degree of osteotomy (≥ 22°) had greater SVA and PT decreases (P < 0.05)., Conclusion: PSO is a quite useful technique of restoring spinal alignment. Lumbar and larger degrees of osteotomy have greater effects on spino-pelvic parameters.

Objective: To explore the impact of the impoundment of Three Gorges reservoir on Oncomelania snail habitats of Poyang Lake., Methods: Four counties with schistosomiasis endemic around the Poyang Lake, naming as Xingzi, Duchang, Jinxian and Xinjian, were selected as study areas. The average daily water level of four major hydrological stations near the above 4 counties from 1997 to 2008 were collected, as well as the elevation of 215 marshlands with snails in those 4 counties, the data of schistosomiasis endemic situation and snail survey of 4 counties in the year before the impoundment of Three Gorges reservoir (2002) and the 6th year after the impoundment of Three Gorges reservoir (2008). The fluctuations of water levels of Poyang Lake, flooding day of marshland with snails as well as the changes of the indicators in snail survey and prevention and control measures before and after the impoundment of Three Gorges reservoir were compared., Results: Before the impoundment of Three Gorges reservoir, the fluctuations of average water level of the four hydrological stations around Poyang Lake was 6.91-12.93 m; which reduced to 5.72 - 10.75 m after the impoundment. The D-value of the fluctuations of average water level was (1.06 ± 0.47) m. The date of the annual maximum water level delayed by an average of 12 d; while the date of annual minimum water level arrived an average of 12 d earlier than the impoundment of Three Gorges reservoir. The average flooding days of marshland with snails were separately (100.04 ± 42.06) d before the impoundment and (64.13 ± 22.30) d after the impoundment. The difference was statistically significant (t = 3.70, P < 0.05). The density of snails in the 4 counties around Poyang Lake was 0.8437/0.1 m(2) after the impoundment; declining by 31.04% from the snail density (1.2234/0.1 m(2)) before the impoundment. The density of infectious snails was 0.0014/0.1 m(2) after the impoundment; dropping by 67.34% from it (0.0042/0.1 m(2)) before the impoundment; the infection rate of snails was separately 0.34% after the impoundment and 0.16% before the impoundment. The difference was statistically significant (χ(2) = 53.25, P < 0.05). The coverage rate of chemotherapy increased from 4.45% (35 558/798 200) in 2002 to 9.80% (79 457/810 400) in 2008; the difference was statistically significant (χ(2) = 17 336.63, P < 0.05). The coverage rate of snail killing increased from 1.35% (389.04/28 824.66) in 2002 to 7.49% (2260.90/30 166.22) in 2008; the difference was also statistically significant (χ(2) = 28 824.66, P < 0.05)., Conclusion: The impact of the impoundment of Three Gorges reservoir shortened the flooding days of marshland with snails and helped the prevention and control of schistosomiasis in Poyang Lake regions as the environment went against the breeding of the snails.

Objective: To investigate the effects of mild hypothermia on the expression of ASIC1a and ASIC2a in the rat hippocampus following global cerebral ischemia-reperfusion, so as to speculate the underlying mechanisms of neuroresuscitation., Methods: Ninety five male SD rats were randomly divided into five groups (n = 19): sham operation group (I), model group (II), mild hypothermia group (III), PcTX1 group (IV), mild hypothermia combined PcTX1 group (V). Transient (15 min) global cerebral ischemia was induced by the four-vessel occlusion. PcTX1 (500 ng/ml) 6 µl were injected into lateral cerebral ventricle immediately after reperfusion in group IV and V, while the equal volume of normal saline was injected into lateral cerebral ventricle immediately after reperfusion in the other three groups. At the same time, mild hypothermia after reperfusion was performed and lasted for 6 hours in group III and V, the rectal temperature was reduced to 32 - 33°C within 15 min, while it was maintained at 36 - 37°C by lamp in other three groups. Determination the expression of ASIC1a and ASIC2a protein at 6 h and 24 h of reperfusion, and the expression of ASIC1a and ASIC2a mRNA at 24 h of reperfusion. Observe the pathomorphological changes of hippocampal CA1 neurons at 24 h of reperfusion. Detect the brain water content at 72 h of reperfusion., Results: The difference in the expression of ASIC1a mRNA and protein among the groups was not changed significantly (P > 0.05). Compared with group I, the expression of ASIC2a mRNA and ASIC2a protein was up-regulated in other groups (P < 0.05). It was significantly higher in group III and V than in group II and IV (P < 0.05). Compared to 6 h of reperfusion, the expression of ASIC2a protein was higher in group II, III, IV and V respectively after 24 h of reperfusion. Compared to group I, the number of pyramidal cells in CA1 region of hippocampus in group II, III, IV and V were decreased at 24 h of reperfusion (P < 0.01). Compared to group II, the number of pyramidal cells in CA1 region of hippocampus in group III, IV and V were increased at 24 h of reperfusion (P < 0.01); and compared to group III and IV, the number of pyramidal cells at 24 h of reperfusion in group V was significantly higher (P < 0.01). Compared to group I, the content of brain water in II, III and IV group were increased at 72 h of reperfusion (P < 0.01). Compared to group II, the content of brain water in group III, IV and V were decreased at 72 h of reperfusion (P < 0.01). Giving mild hypothermia or PcTX1 could alleviate the damage in CA1 region of hippocampus, with the best effect in group V, which administers PcTX1 combined mild hypothermia., Conclusion: Mild hypothermia attenuates global cerebral ischemia-reperfusion of rat, which may up-regulate the expression of ASIC2a mRNA and protein. Mild hypothermia combined by PcTX1 could induce neuroresuscitation.

Objective: To explore the changes of extracellular glutamate (Glu) and γ-aminobutyric acid (GABA) in hippocampus during the high-frequency stimulation of anterior nucleus thalamus (ANT) in epileptic rats., Methods: A total of 30 rats were divided equally into 2 groups:epilepsy model and normal control (n = 15 each). Concentric bipolar electrodes were stereotaxically implanted in bilateral ANT. A high-frequency stimulation of 130 Hz was applied in the epilepsy group. Microdialysis probes were unilaterally lowered into hippocampus. The concentrations of Glu and GABA in dialysate samples were determined by high-performance liquid chromatography (HPLC)., Results: Electrical stimulation of ANT induced an increase of GABA and a decrease of Glu in hippocampus., Conclusion: An increase of GABA and a decrease of Glu during the electrical stimulation of ANT play an important role in the therapy of epilepsy.

Objective: To explore the relationship between serum uric acid levels and patient conditions and prognosis in idiopathic pulmonary arterial hypertension (IPAH)., Methods: A total of 76 IPAH patients confirmed by right heart catheterization were enrolled consecutively and followed up until the endpoint of all-cause death. Their baseline data were recorded and analyzed by Spearman's rank test and independent t-test. And the follow-up outcomes were analyzed with Kaplan-Meier plots., Results: There were 27 males and 49 females with a mean age of 29.7 ± 9.7 years. They were classified into World Health Organization functional class (WHO-FC)II (n = 28), class III (n = 45) and class IV (n = 3). Their baseline mean pulmonary artery pressure was (65 ± 16) mm Hg, pulmonary vascular resistance (1677 ± 669) dyn×s(-1)×cm(-5), pulmonary capillary wedge pressure (9.6 ± 5.0) mm Hg, mean right atrial pressure (9.8 ± 6.1) mm Hg, cardiac index (2.07 ± 0.57) L ×min(-1)× m(-2) and serum uric acid (391 ± 103) µmol/L. The correlation analysis indicated that the serum level of uric acid correlated positively with right ventricular diameter (r = 0.28, P = 0.018) and negatively with CI (r = -0.34, P = 0.003). Independent t-test results indicated that the patients with a higher level of uric acid were apt to have a worse WHO-FC, and the higher level uric acid group (serum uric acid > 416.5 µmol/L) had a relative higher level of WHO-FC, NT-proBNP and endothelin-1. A lower level of CI denoted more severe conditions and prognosis. Survival analysis indicated that the serum level of uric acid could strongly predict survival in IPAH patients with over time and those with a high level of uric acid had a worse prognosis., Conclusion: The serum level of uric acid correlates significantly with patient conditions and prognosis in IPAH. And a higher serum level of uric acid predicts worse conditions and prognosis.

Objective: To analyze diagnostic evaluation of urethral sphincter electromyography (US-EMGs) for patients with multiple system atrophy (MSA)., Methods: Totally 15 patients who were diagnosed as MSA were examined as treatment group while 17 non-MSA patients were examined as controls. US-EMGs were performed in the both groups. Spontaneous activities when relax, parameters of motor unit potentials (MUPs) mean duration and amplitude, percentage of polyphasic ware, satellite potential, recruitment potentials and amplitude when strong contraction were recorded and analyzed., Results: US-EMGs changes of various abnormalities were found in 13 cases (86.7%) in MSA group. There were significant differences of electromyographic findings between the MSA group and control group including MUPs mean duration [(12.79 ± 3.18) ms vs (9.49 ± 1.51) ms] and amplitude [(828.53 ± 459.89) µV vs (378.76 ± 152.26) µV] as well as recruitment potentials [(11.47 ± 21.55)% vs (8.23 ± 10.74)%] and amplitude [(2.19 ± 1.24) mV vs (0.75 ± 0.42) mV] when strong contraction (all P values < 0.05)., Conclusions: There is certain value of US-EMGs for the diagnosis of MSA. It could be used as a routine electrophysiological method for the patients who are suspected of MSA. It could be a supplement of external anal sphincter electromyography.

Objective: To examine the trends of energy intake among Chinese children and adolescents in nine provinces from 1989 to 2009., Method: Stratified multi-stage cluster sampling method was used to recruit 488, 2807, 2802, 2580, 2520, 1604, 1305 and 1159 children and adolescents aged 6 - 17 years in each year of 1989, 1991, 1993, 1997, 2000, 2004, 2006 and 2009 in 9 provinces. The descriptive analyses were carried out for three days 24-h dietary recall data to compare energy intake by year and demographic characteristics., Results: The median of dietary energy intake among Chinese children and adolescents aged 6 - 17 years in 1989, 1991, 1993, 1997, 2000, 2004, 2006 and 2009 were 6645.7, 8314.8, 7849.3, 8115.0, 7970.5, 7598.0, 7345.0 and 7051.9 kJ/d (χ(2) = 239.75, P < 0.01), respectively. In 2009, children and adolescents from city (7820.4 kJ/d) and county (7356.0 kJ/d) consumed more energy than that from suburb (7168.2 kJ/d) and village (6863.5 kJ/d) (χ(2) = 8.00, P < 0.05). Cereal was the main food source of energy intake. In 2009, the percentage of energy intake from cereal was 44.0%, 45.6%, 52.9% and 61.0% (χ(2) = 36.75, P < 0.01)for city, suburb, county and village respectively. The percentage of population with > 30% of energy intake from dietary fat increased yearly and that with more than 60% of energy from carbohydrate decreased, from 25.4% (124/488) and 54.1% (264/488) in 1989 to 58.1% (637/1159) and 15.9% (184/1159) (χ(2) values were 811.24, 919.35 respectively;both P values < 0.05) in 2009. The percentage of children and adolescents whose energy intake was more than 80% recommended nutrient intake (RNI) declined from 60.2% (294/488) in 1989 to 47.8% (554/1159) in 2009(χ(2) = 227.66, P < 0.05)., Conclusion: The current study demonstrated that energy intake of Chinese children and adolescents increased at early stage and then declined in the recent years. Average energy intake was higher in city and county than suburb and village.

Objective: To examine status and trend in dietary vitamin C intake between 1991 and 2009 in Chinese children and adolescents aged 6 to 17 years., Methods: A stratified multistage, random cluster sampling process was used to investigate 2716, 2691, 2507, 2358, 1490, 1218 and 1073 children and adolescents aged 6 - 17 years in 1991, 1993, 1997, 2000, 2004, 2006 and 2009 respectively in 9 provinces. Their consecutive 3 d 24 h dietary recall data were analyzed to compare vitamin C intake in children and adolescents with different characteristics and different years., Results: The median of dietary vitamin C intake in Chinese children and adolescents decreased from 69.7 mg/d in 1991 to 53.4 mg/d in 2009 (χ(2) = 188.1, P < 0.01). Vitamin C intake of rural children and adolescents decreased from 73.7 mg/d in 1991 to 52.5 mg/d in 2009 (χ(2) = 96.7, P < 0.01); vitamin C intake of children and adolescents in the low-income household decreased from 74.3 mg/d in 1991 to 47.5 mg/d in 2009 (χ(2) = 172.9, P < 0.01). The percentage of children and adolescents whose vitamin C intake equal or higher than recommended nutrient intake of vitamin C decreased from 35.9% (974/2716) in 1991 to 18.5% (198/1073) in 2009 (χ(2) = 284.7, P < 0.01)., Conclusion: There was a decreased trend in dietary vitamin C in Chinese children and adolescents during the past two decades. The children and adolescents of low-income household in rural areas may pose a higher risk of inadequate vitamin C intake.

Objective: To summarize the clinical features and neuroimaging findings of the patients with acute disseminated encephalomyelitis (ADEM) involved in corpus callosum (CC) so as to distinguish it from other diseases., Methods: A total of 12 ADEM patients with the involvement of CC during the period of 2010-2012 were recruited. There were 9 males and 3 females with a mean age of 31±14 years (range: 10-54). Their clinical and neuroimaging features were retrospectively reviewed and all data analyzed by SPSS 18.0., Results: (1) All of them had an acute or subacute onset. Two patients had a history of vaccination and 5 suffered upper respiratory tract infection or diarrhea. (2) The presenting symptoms included fever (n=5), headache (n=4), unsteady gait (n=2), urinary retention (n=1), indifference (n=1) and delirium (n=1). (3) The main clinical symptoms included memory loss (n=9), delirium (n=5), somnolence (n=4), urinary retention (n=9), paraplegia (n=4) and unsteady gait (n=5). (4) The examinations of cerebrospinal fluid (CSF) revealed increased intracranial pressure (n=4), leucocytosis (n=3) and increased protein (n=7) of 7 cases. All oligoclonal bands were negative. (5) The lesions were involved in bilateral CCs in 12 patients. Among them, splenium was the most commonly affected (n=9), secondly stem (n=5) and lastly genu (n=4). For 6 patients, the intracranial lesions were all in their CCs. And among them, 2 cases were involved in spinal cord. Except for CC, there were other focal lesions in brain stem and cerebellum (n=4) and spinal cord (n=6). (6) On magnetic resonance imaging (MRI), all cases showed long T2 signal intensity with blurred images. And among them, 2 cases' lesions in brain were discerned only by diffuse weighing imaging (DWI) or T2 fast fluid-attenuated inversion recovery (T2FLAIR) instead of T2-weighted. The lesions of CCs showed on gadolinium-enhanced MRI were significantly enhanced and the shapes were sheet-like (4/6). Spinal cord lesions was found in 6 cases and most spinal cord lesions were discontinuous. And the number of spinal cord segments with lesions was from 4 to 8. The shapes of lesions of spinal cord showed on enhanced MRI were like thin line. (7) Most of them were misdiagnosed as viral encephalitis (n=5), tuberculous meningoencephalitis (n=1) and brain neoplasms (n=2). And another case was admitted into urology surgery ward due to urinary retention., Conclusion: There are three key points about the characteristics of the ADEM patients with CC lesions: (1) They may have an adult male preponderance. The distinctive symptoms include fever, headache, delirium, somnolence, memory loss, unsteady gait and urination disorders, etc.. (2) The number of lesions on brain MRI can be multiple or single, especially the lesions of CC (mostly in splenium). On MRI, all cases showed long T2 signal intensity with blurred images so that DWI and T2 FLAIR may have a higher efficiency of detecting the lesions. In particular, multiple lesions may be all enhanced or not enhanced at equal pace on enhanced MRI. (3) In ADEM patients with CC lesions, many indices of CSF chemical examination, such as increased intracranial pressure, leucocytosis, increased protein, low sugar and low chloride, indicate the presence of intracranial infective diseases. Therefore they are most likely to be misdiagnosed as viral encephalitis or tuberculous meningoencephalitis. However, CC is not the predilection site for viral encephalitis since CC belongs to white matter but not gray matter. So ADEM should be a more appropriate diagnosis for these cases.

Objective: To investigate the effect of vascular endothelial growth factor 165 (VEGF 165) gene on vascularization of dermal substitute in vivo., Methods: Human umbilical vein endothelial cells (HUVECs) were cultured in M199 medium containing FBS in the volume fraction of 10% (briefly called complete medium). (1) HUVECs were divided into non-transfection group (without transfection), empty vector group [transfected with pIRES2-enhanced green fluorescent protein (EGFP) plasmid], and VEGF plasmid group (transfected with pIRES2-EGFP-VEGF plasmid) according to the random number table, with 6 wells in each group. At post transfection hour (PTH) 24, the expression of green fluorescent protein (GFP) in each group was observed under inverted phase contrast fluorescence microscope, and the expression rate of GFP was detected with flow cytometer. Cells in non-transfection group were tested with the same methods as listed above. The cells in stable transfection in empty vector group and VEGF plasmid group were sifted by neomycin. The mRNA and protein expression levels of VEGF 165 in cells and the protein amount of VEGF 165 in the supernatant of cell culture medium in 3 groups were respectively determined by real-time fluorescent quantitation PCR, Western blotting, and enzyme-linked immunosorbent assay. (2) Forty-eight male nude mice were divided into 4 groups according to the random number table, with 12 mice in each group. Mice in saline group were subcutaneously implanted with dermal substitutes which had been cultured in saline for 2 days on both sides of back (the same site below); mice in medium group were subcutaneously implanted with dermal substitutes which had been cultured in complete medium for 2 days; mice in non-transfected cells group were subcutaneously implanted with dermal substitutes that had been cultured in complete medium with non-transfected HUVECs for 2 days; mice in transfected cells group were subcutaneously implanted with dermal substitutes that had been cultured in complete medium with HUVECs stably transfected with VEGF plasmid for 2 days. The dermal substitutes in every group were taken out on post operation day (POD) 3, 7, 14, and 21. Distributions of microvessels and HUVECs in dermal substitutes were observed by immunohistochemical staining, and the microvessel number was counted on POD 14; the expression level of VEGF 165 protein in dermal substitutes was determined by Western blotting. The experiments were all done in triplicate. Data were processed with one-way analysis of variance and LSD method., Results: (1) Obvious green fluorescence was only observed in the two groups with transfected cells at PTH 24. Expression rates of GFP in the cells of non-transfection group, empty vector group, and VEGF plasmid group were respectively 0, (85.2 ± 3.2) %, and (93.1 ± 2.4) %. In the non-transfection group, empty vector group, and VEGF plasmid group, the relative expression amounts of VEGF 165 mRNA were respectively 1, 1.05 ± 0.09, and 3.02 ± 0.13 (F = 5.28, P < 0.05); the relative expression amounts of VEGF 165 protein were respectively 0.78 ± 0.16, 0.76 ± 0.13, and 1.92 ± 0.18 (F = 7.62, P < 0.05); the protein quantity of VEGF 165 in cell supernatant was respectively (62.4 ± 2.7), (73.1 ± 3.8), (117.5 ± 3.1) pg/mL (F = 15.08, P < 0.05). The mRNA and protein levels of VEGF 165 and VEGF 165 protein amount in supernatant were significantly higher in VEGF plasmid group than in the other two groups, with P values all below 0.05. (2) The number of HUVECs in dermal substitutes of transfected cells group was significantly higher than that of the other three groups on POD 14. The numbers of microvessels of dermal substitutes on POD 14 in saline group, medium group, non-transfected cells group, transfected cells group were respectively 4.2 ± 1.1, 5.2 ± 1.1, 6.6 ± 0.9, 13.8 ± 0.8 per 200 times visual field (F = 17.96, P < 0.01). The microvessel number in transfected cells group was significantly higher than that of the other three groups, with P values all below 0.05. The relative expression ratio of VEGF 165 protein of dermal substitutes in transfected cells group was significantly higher than that in saline group as of POD 7. On POD 14 and 21, the relative expression ratios of VEGF 165 proteins in non-transfected cells group (1.652 ± 0.086, 2.152 ± 0.062) and transfected cells group (2.403 ± 0.091, 2.879 ± 0.047) were significantly higher than those of saline group (1.299 ± 0.027, 1.362 ± 0.103), with P values all below 0.05. And the index level of transfected cells group was significantly higher than that in non-transfected cells group (with P values below 0.05). The VEGF 165 protein content in dermal substitutes increased with time extension in all groups., Conclusions: Transfection of VEGF 165 gene in HUVEC could effectively facilitate vascularization of dermal substitutes in vivo by high expression of VEGF 165 protein.

Objective: To compare the efficacies between transjugular intrahepatic portosystemic shunt (TIPS) and portoazygos devascularization (PAD) in the treatment of portal hypertension with variceal bleeding., Methods: From December 1993 to December 2010, 309 patients with portal hypertension and variceal bleeding were admitted. According to their general conditions and Child-Pugh grades, they were assigned to undergo TIPS (group A, n = 235) or PAD (group B, n = 74). Before operation, compared with the PAD group, the TIPS group possessed worse liver functions, more severe ascites and a greater frequency of bleeding. After operation, the therapeutic efficacies and changes of portal hemodynamics, recurrent variceal bleeding, post-operative encephalopathy and long-term survival were evaluated between two groups., Results: The postoperative portal pressure in the TIPS group ((42.6 ± 7.0) vs (26.3 ± 4.1) cm H2O) decreased much more than that in the PAD group ((38.7 ± 5.2) vs (33.5 ± 5.8) cm H2O, P < 0.01). The rebleeding rates during early postoperation were 0.85% (2/235) and 6.76% (5/74) in TIPS and PAD groups respectively, the occurring rates of hepatic encephalopathy 4.68% (11/235) and 4.05% (3/74) and the rates of operative mortality 1.70% (4/235) and 6.76% (5/74) respectively. Survival rates of 1, 3, 5 and 10 years were 98.30% (231/235) vs 92.24% (69/74), 92.41% (146/158) vs 88.06% (59/67), 80.77% (84/104) vs 79.25% (42/53), 51.43% (36/79) vs 51.85% (14/27) in TIPS and PAD groups respectively., Conclusions: As compared with PAD, TIPS offers the such advantages as less trauma, wider indication, faster hemostasis and satisfactory therapeutic efficacies. Especially for the emergency treatment of a patient with massive variceal bleeding and Child-Pugh C grade liver function, TIPS is a better option than PAD.

Objective: To examine dietary protein intake and its trend between 1991 and 2009 among Chinese children and adolescents aged 6 to 17 years., Methods: Consecutive 3 d-24 hr Dietary Recall and household income data of 14 053 children from the seven waves of the China Health and Nutrition Survey (CHNS), 1991, 1993, 1997, 2000, 2004, 2006 and 2009 were used to describe long-term changes in dietary protein intake, percentage energy, and food sources., Results: The median of dietary protein intake of Chinese children and adolescents decreased from 60.0 g/d in 1991 to 52.6 g/d in 2009 (χ² = 109.0, P < 0.01). The dietary protein intake among children in rural areas and in low-income households decreased 8.8 g/d (χ² = 74.8, P < 0.01) and 9.8 g/d (χ² = 100.5, P < 0.01) respectively. The percentage of total energy intake from protein was 11.3%-13.0%. The percentage of protein intake equal or higher than Recommended Nutrient Intake of protein decreased from 29.5% in 1991 to 19.2% in 2009 (χ² = 259.6, P < 0.01). Furthermore, the proportion of high-quality dietary protein increased rapidly. The percentage of animal protein increased from 12.3% in 1991 to 32.2% in 2009 (χ² = 750.3, P < 0.01), while no big increase in soybean protein (lower than 5.0%)., Conclusion: There is a decreasing trend in dietary protein intake among Chinese children from 1991 to 2009. The high-quality protein intake was improved but we should be concerned about the high proportion of animal protein. The children living in low-income households and in rural areas may be at risk of inadequate dietary protein.

Objective: To explore the demographic characteristics and clinical features of patients with idiopathic pulmonary arterial hypertension (IPAH) in China., Methods: Between March 2007 and September 2010, IPAH diagnosis was confirmed by right heart catheterization in 150 adult patients from 31 clinical centers in China. Clinical and hemodynamic data were analyzed and patients were divided into WHO functional class I/II and WHO functional class III/IV group., Results: The mean age of 150 patients were 36 ± 13 years with female patient/male patient ratio of 2:1, and mean BMI was (21.3 ± 3.5) kg/m(2). Fatigue (n = 123, 82.0%) and dyspnea (n = 112, 74.7%) are the most common symptoms. Accentuated pulmonic second sound (P(2)) was detected in 92.0% (n = 138) of patients during physical examination, which was also the most common sign. About 49.0% (n = 73) patients were WHO functional class I/II patients and 46.0% (n = 68) patients were WHO functional class III/IV patients. Six minutes walking distance (6MWD) and Borg dyspnea score was (337 ± 101) m and 2.0 (2.0, 4.0), respectively. Right ventricular hypertrophy was suggested by ECG in 93.1% (n = 140) patients. Right atrial pressure was (10 ± 6) mm Hg, mean pulmonary artery pressure was (61 ± 16) mm Hg, cardiac index was (2.3 ± 0.8) L×min(-1)×m(-2) and pulmonary vascular resistance (1484 ± 699) dyn×s(-1)×cm(-5) in this cohort. 6 MWD (305 m ± 89 m vs. 377 m ± 88 m) was significantly shorter while Borg dyspnea score [3.0 (3.0, 5.0) vs. 2.0 (2.0, 3.0)] was significantly higher in WHO functional class III/IV patients than in WHO functional class I/II patients. Similarly hemodynamic parameters were also worse in WHO functional class III/IV patients than in WHO functional class I/II patients (all P < 0.05)., Conclusion: Idiopathic pulmonary arterial hypertension patients in this cohort affect mostly young adults, dominated by female gender and lower body mass index. Fatigue and dyspnea are the most common symptoms and accentuated pulmonic second sound (P(2)) is the most common sign. IPAH patients are often displaying severe functional and hemodynamic disturbance at first visit to hospitals. Dyspnea and hemodynamic impairment are related to 6MWD and WHO functional class.

Objective: To elucidate the effect of transforming growth factor-beta 1 (TGF-β1) on peritoneal fibrosis and the regulation of gastric cancer adhering to mesothelial cells., Methods: The peritoneal mesothelial cell line of HMrSV5 was used to determine the role of TGF-β1 in the regulation of gastric cancer cell adhering to mesothelial cells. And the mRNA and protein expressions of collagen III and fibronectin were detected by adhesion assay, Western blot, immunofluorescent staining and reverse transcription-polymerase chain reaction (RT-PCR)., Results: (1) The treatment of 5 ng/ml TGF-β1 could induce the expressions of collagen III and fibronectin in mesothelial cells at 24, 48 and 72 h (P < 0.01). (2) As compared with the controls, the percentages of adhered HGC-27 and HSC-39 gastric cancer cells significantly increased under the treatment of TGF-β1 for 24 and 72 h. The increased adhesion percentages of HGC-27 were 65% ± 5% and 124% ± 11% (P < 0.05) while those of HSC-39 85% ± 9% and 146% ± 17% respectively (P < 0.05). (3) Arginyl-glycyl-aspartic acid (RGD) (knockdown of minimal sites for cell-binding domain of extracellular matrix) decreased the number of cancer cells adhering to mesothelial cells under the stimulation of TGF-β1. And the decreased adhesion percentage of HGC-27 was 65% ± 8% (P < 0.05)., Conclusions: TGF-β1 significantly stimulates the expressions of collagen III and fibronectin in mesothelial cells. And it is associated with the increased adhesion of gastric cancer cell and offers a favorable environment for the dissemination of gastric cancer.

Objective: To summarize and analyze the complications of posterior vertebral column resection in the treatment of spinal tumors., Methods: The complications of 31 patients were recorded and categorized into primary and secondary complications. Many factors such as segment, bleeding volume and surgical duration were reviewed. The SPSS 12.0 software was used to analyze the relations between the complications and these factors retrospectively., Results: Two primary and 30 secondary complications were identified. A definite relation existed between the delayed removal of endotracheal intubation and bleeding volume. And a definite relation existed also between transient thrombocytopenia and operative duration. There was no relation between prosthetic subsidence and various factors (including follow-up period)., Conclusion: Most complications are secondary and have basically no effect on the recovery of patients. And prevention are feasible in most cases. So a thorough plan should be devised to prevent the occurrences of potential complications, especially primary ones. For any occurrence, active treatment should be offered to improve the surgical safety.

Objective: To observe the prognostic value of admission B-type natriuretic peptide (BNP) on outcome for patients with congestive heart failure (CHF)., Methods: Blood BNP levels, routine echocardiography and tissue Doppler image were obtained in 162 CHF patients [95 male, mean age: (71.8±3.7) years] at admission. Patients were divided into high BNP (BNP>1500 ng/L, n=104) and low BNP (BNP≤1500 ng/L, n=58) groups. All patients were followed up for 2 years and clinical characteristics, echocardiography including Doppler image and cardiovascular events results were analyzed. Data were also compared between patients with (n=48) or without (n=107) cardiovascular events., Results: Left ventricular ejection fractions (LVEF) was significantly lower [(40.9±5.6)% vs. (44.0±5.9)%, P<0.01] while the total cardiovascular events rate (49.1% vs. 21.0%, P<0.01) and cardiac mortality rate (25.5% vs. 9.0%, P<0.01) were significantly higher in high BNP group than in low BNP group. BNP level at admission in event group was significantly higher than in event-free group [(2875.4±325.7) ng/L vs. (1136.9±298.6) ng/L, P<0.000]. BNP level was positively related to Tei-index (r=0.793, P<0.001) and negatively correlated with LVEF (r=-0.57, P<0.001). Multiple logistic regression analysis demonstrated that BNP, LVEF, Tei-index and β-blocker use were independent risk factors for cardiovascular events. The area under the ROC curve for predicting cardiovascular death within 2 years in event group by BNP was 0.795 (95%CI 0.693-0.935, sensitivity: 72.31% and specificity: 84.62%, cut-off BNP value: 1910 ng/L). The event risk was 2.17 times higher in CHF patients with admission BNP>1910 ng/L compared CHF patients with admission BNP≤1910 ng/L (95%CI: 1.852-2.954, P=0.000)., Conclusion: Admission BNP level, LVEF, Tei-index and β-blocker use are independent risk factors for cardiovascular events in patients with CHF. Patients with higher admission BNP level (>1910 ng/L) is linked with worse prognosis in this patient cohort.

Objective: To determine the prevalence and influencing factors of pulmonary arterial hypertension (PAH) in patients with congenital heart disease (CHD)., Methods: Between May 2007 and December 2008, a total of 692 CHD patients admitted into Fuwai Hospital were prospectively enrolled. Doppler echocardiography was employed to measure the level of pulmonary artery systolic pressure (PASP). PAH occurred when there was an increase in PASP > 40 mm Hg (1 mm Hg = 0.133 kPa) at rest. Eisenmenger syndrome was defined when there was a reversed (pulmonary-to-systemic) or bidirectional shunt. The clinical characteristics between the patients with/without PAH and Eisenmenger syndrome were compared and their risk factors analyzed with a multivariate Logistic model., Results: The underlying conditions included atrial septal defect (n = 187, 27.0%), ventricular septal defect (n = 456, 65.9%) and patent ductus arteriosus (n = 49, 7.1%). The numbers of patients with PAH-CHD and Eisenmenger syndrome were 329 (47.5%) and 105 (15.2%) respectively. Among the PAH-CHD patients, 31.9% of them had Eisenmenger syndrome. The patients with large shunts were at an elevated risk of PAH. Logistic regression analysis showed that advanced age was an independent risk factor of PAH (OR = 1.04, P < 0.001). Compared with atrial septal defect, ventricular septal defect and patent ductus arteriosus increased the risks of PAH (OR = 2.78, P < 0.001 and OR = 2.50, P < 0.001 respectively)., Conclusions: PAH is a common complication in CHD patients. And ventricular septal defect is the most common pathogenic type of PAH. Advanced age, ventricular septal defect and patent ductus arteriosus are the risk factors of PAH.

Objective: To understand the demographic, hemodynamic and clinical features of adult patients with pulmonary hypertension (PH) in China., Methods: Between May 2007 and October 2010, a total of 551 adult PH patients were recruited from 31 clinical centers all over China. All fulfilled the traditional hemodynamic criteria diagnosed through right heart catheterization (RHC). The relevant data of demographic, clinical and hemodynamic features of all patients, analyzed the similarities and differences of demographic characteristics between different subtypes. They were divided into 2 groups: WHO functional class I/II and III/IV. And their hemodynamic and clinical features were compared., Results: There were 165 males and 386 females with a mean age of (35 ± 12) years. The mean body mass index (BMI) was (21 ± 4) kg/m(2). There were pulmonary arterial hypertension (PAH, n = 487) and chronic thromboembolic pulmonary hypertension (CTEPH, n = 64). Fatigue (421, 76.4%) and dyspnea (398, 72.2%) were the most common symptoms; Physical examination revealed such a common sign as an accentuated pulmonic second sound (P(2)) in 510 patients (92.6%). Over half (325, 59.0%) of them were of WHO functional class II and 213 (38.6%) patients functional class III. The 6-minute walking distance (6MWD) and Borg dyspnea score were (352 ± 91) m and 3.0 (2.0 - 4.0) respectively. ECG of 497 (90.2%) patients showed right ventricular hypertrophy. Mean right atrial pressure was (9 ± 6) mm Hg (1 mm Hg = 0.133 kPa), pulmonary arterial pressure (67 ± 20) mm Hg, cardiac index (2.7 ± 1.2) Lmin(-1)m(-2) and pulmonary vascular resistance (1496 ± 783) dyn.sec.cm(-5)., Conclusions: Young females with a low BMI are predominantly affected by PH. Severe functional and hemodynamic compromises often appear on presentation. And hemodynamic impairment is correlated with 6MWD and WHO functional class.

Objective: To explore the surgical techniques and efficacies of deep brain stimulation (DBS) in the treatment of the patients with essential tremor (ET)., Methods: A total of 6 ET patients from January 2004 to June 2011 at Department of Neurosurgery, Beijing Tiantan Hospital were recruited to receive DBS at ventral intermediate nucleus of thalamus (Vim-DBS) (n = 5) and subthalamic nucleus (STN-DBS) (n = 1). All underwent stereotactically guided DBS procedures utilizing atlas of neuroanatomy and neurophysiology, pre-operative magnetic resonance imaging (MRI), microelectrode recording and intra-operative testing for target-locating. Postoperative computed tomography (CT) and/or MRI scan were performed after implantation. Such stimulation parameters as stimulus voltage, frequency, pulse width and polarity configuration were adjusted postoperatively to optimize tremor control and maximize battery life. The patients were followed by further consultations or telephone for a comprehensive evaluation of their therapeutic efficacies., Results: All patients showed typical electrical signal and relief of tremor symptoms with significant tremor control. No severe adverse events, such as infection, hemorrhage, paresthesia, dysarthria, cognitive deficits, imbalance and diplopia, appeared after the implantation of DBS electrodes., Conclusion: Vim-DBS and STN-DBS are both safe and effective for the controls of unilateral and bilateral tremors.

Objective: To Compare the two techniques in the treatment of congenital kypho-scoliosis caused by fully-segmented hemivertebra., Methods: 44 consecutive cases, 21 males and 23 females. The average age at surgery was 11.4 years ranging from 2 to 17 years, 20 patients underwent one-stage anterior and posterior hemivertebra resection and instrumentation. 24 patients underwent one-stage posterior hemivertebra resection and instrumentation. Long cassette standing radiographs were taken before and after surgery and at the final follow-up. The apical translation, the Cobb's angle in the coronal and sagittal plane were measured and analyzed. The medical records were reviewed and the complications were recorded., Results: The average follow-up was 39.2 months ranging from 24 to 72 months. The 2 groups did not demonstrate any significant differences in gender, age at surgery, preoperative and postoperative Cobb angle, blood loss, or fusion segments (all P > 0.05). However, the anterior and posterior group demonstrated a less curve flexibility and longer operative time compared with the posterior groups (all P < 0.05)., Complications: the anterior and posterior group included pedical cutting in 1 case, lumber curve decompensation in 1 case and crankshaft phenomenon in 2 cases. The posterior group included pedical cutting in 1 case and length of instrumentation in 1 case., Conclusions: Two techniques are safe and effective procedure for the congenital kypho-scoliosis. Anterior and posterior hemivertebra resection is indicated to rigid deformity, and anterior epiphysiodesis is needed to avoid crankshaft phenomenon for patients at an earlier skeletal age. Posterior hemivertebra resection can save operation time and is less invasive compared with anterior-posterior approach.

Objective: To explore the clinical manifestations and surgical strategies of scoliosis associated with syringomyelia., Methods: A total of 50 cases diagnosed as scoliosis with syringomyelia between January 2003 and November 2010 were recruited. They were divided into 2 groups: Group A, neurosurgery before scoliosis correction, including suboccipital decompression and syrinx shunting; Group B, one-staged posterior correction and instrumentation without previous neurosurgery. The preoperative, postoperative and last follow-ups of Cobb angle of coronal main curve and thoracic kyphosis were measured. Also the preoperative and postoperative apical vertebra translation, apical vertebra rotation and trunk shift were measured by the same person. The surgical efficacies and complications of correction were compared between 2 groups., Results: All patients underwent posterior pedicle screw instrumentation and had a mean follow-up period of 32.1 months. Among them, 42 patients had clinical symptoms or signs preoperatively and 3 patients improved postoperatively. The mean correction of coronal curve was 65.7% and a mean loss of correction 6.4% during the follow-up. The mean correction of apical vertebra translation and apical vertebra rotation were 63.0% and 60.0% respectively. However, the trunk shift increased 0.4 cm. There were no statistically significant differences for the correction efficacies and complications between 2 groups (P > 0.05)., Conclusion: Scoliosis associated with syringomyelia may be effectively managed if a surgeon manipulates carefully intraoperatively and perioperative spinal monitoring is practiced. Furthermore syrinx will not increase the incidence of postoperative complications without prophylactic neurosurgery.

Objective: To evaluate the safety and effect of sirolimus (SIR) substitution for calcineurin inhibitors (CNI) in chronic allograft nephropathy (CAN)., Methods: A prospective, open-label and non-randomized comparative study was performed in 74 kidney recipients from January 2004 to June 2006 with a diagnosis of CAN at a baseline estimated glomerular filtration rate (eGFR) of 30 - 60 ml×min(-1)·(1.73 m(2))(-1). Patients in the SIR group (n = 36) received SIR at 12 hours after a cessation of CNI. For those in the CNI group (n = 38), a cyclosporine (CsA)-based immunosuppressive regimen was prescribed in 30 patients and a tacrolimus (FK506)-based regimen in another 8 patients. All patients were maintained under a high level of mycophenolate mofetil and followed up for 4 years to evaluate the renal function, eGFR, blood routines, blood lipids and liver function, etc., Results: The renal function and eGFR profiles of the SIR group improved significantly after substitution. The baseline eGFR was (40 ± 7) ml×min(-1)·(1.73 m(2))(-1) in the SIR group versus (38 ± 6) ml×min(-1)·(1.73 m(2))(-1) in the CNI group (P > 0.05). In SIR group, the levels of eGFR were higher than those in the CNI group at months 3, 12, 24, 36 and 48 (all P < 0.05). For the endpoint of serum creatinine doubling, the 4-year survival was 75.0% in the SIR group versus 50.0% in the CNI group (P = 0.03). There were 2 cases of acute rejections, 1 proteinuria, 1 pneumonia in the SIR group while 2 patients in the CNI group dropped out as a result of acute rejections (P > 0.05). The total bilirubin value of all the patients decreased significantly but serum cholesterol and triglyceride levels increase significantly after conversion (all P < 0.05)., Conclusion: The substitution of SIR for CNI is both safe and effective in renal transplant recipients with CAN. And a conversion from CNI to SIR may improve the graft survival.

Objective: To evaluate the predicting value of Wells, Kahn, St. André and Constans scores for the diagnosis of deep venous thrombosis in Chinese patients., Methods: A total of 274 patients suspected with deep venous thrombosis was prospectively blinded evaluated with the four clinical-score systems. Sensitivity, specificity, positive predictive value, negative predictive value and receiver operation curves were calculated for four clinical scores according sonography results., Results: Sonography evidenced deep venous thrombosis in 88 out of 274 patients. The sensitivity, specificity, positive predictive value and negative predictive value was 77.3%, 65.6%, 51.5% and 85.9%, respectively, for Wells score; 58%, 55.9%, 38.3% and 73.8%, respectively, for Kahn score; 64.8%, 55.4%, 40.7% and 76.9%, respectively, for St. André score and 86.4%, 37.6%, 39.6% and 85.4%, respectively, for Constans score. ROC was 0.761 for Wells score, which was similar as that of Constans score (0.759), then followed by St. André score (0.627) and Kahn score (0.591)., Conclusion: Our results showed that Wells score and Constans score are superior to Kahn score or St. André score for diagnosing patients with suspected deep venous thrombosis in terms of sensitivity, negative prediction value and ROC values.

Objective: To explore the status and trend of cereal consumption among Chinese adults aged 18 to 59 years in nine provinces (municipality) from 1989 to 2006., Methods: The survey data were collected by consecutive 3 d 24 h dietary recall method in 1989, 1991, 1993, 1997, 2000, 2004 and 2006 China Health and Nutrition Survey Project. The subjects aged 18-59 years with complete information on dietary survey were included. The sample number of the subjects were 5978, 7566, 7492, 7738, 8439, 7484 and 7157 in the 7 round surveys from 1989 to 2006, respectively. The trends of their cereal consuming rate and daily intake were analyzed by year, gender, age and regions., Results: The cereal intake of 18 - 59 years old Chinese adults in 9 provinces (municipality) decreased from 522.3 g/d in 1989 to 431.9 g/d in 2006 (χ(2) = 2421.76, P < 0.01). The cereal intake of males decreased from 545.6 g/d in 1989 to 471.6 g/d in 2006 (χ(2) = 861.21, P < 0.01) and females decreased from 500.3 g/d in 1989 to 395.5 g/d in 2006 (χ(2) = 1844.13, P < 0.01). Compared with 1989, the average cereal consumption were reduced to 104.8, 134.4, 103.3 and 98.2 g in the suburban, female, 18 to 29 years old age group and level of education for college and above separately in 2006. The rice consuming rate among 18 - 59 year-old residents increased from 79.9% (4776/5978) in 1989 to 87.3% (6248/7157) (Z = 18.45, P < 0.01) in 2006, the wheat consuming rate increased from 63.3% (3784/5978) in 1989 to 80.2% (5740/7157) (Z = 27.28, P < 0.01) in 2006., Conclusion: The present study indicated that there was a decreasing trend of cereal intake among Chinese adults aged 18 - 59 years in 9 provinces (municipality). In the stratified groups, cereal intake in groups of female, suburb, aged 18 - 59 years and higher educational level decreased significantly.

Objective: To investigate the qualitative accuracy of pulmonary artery systolic pressure (PASP) as estimated by transthoracic Doppler echocardiography (TDE)., Methods: A retrospective study was conducted on 102 adult patients with idiopathic pulmonary arterial hypertension undergoing Doppler echocardiography within 72 hours prior to right heart catheterization. During this period, all patients were stable without any specific drug therapy. Compared with right heart catheterization, the accuracy of PASP as measured by TDE was evaluated., Results: Among them, there were 38 males and 64 females with an average age of (31 ± 11) years old (range: 18 - 59 years old). There was a moderate correlation between the measurements of PASP by TDE and right heart catheterization (r = 0.64, P < 0.01). Through the analysis of Bland-Altman, the bias for the TDE estimates of PASP was 6.7 mm Hg with a 95% limit of agreement ranging from -47.6 to 34.3 mm Hg. There were 60 (58.8%) cases with absolute differences over 10 mm Hg between two methods. Overestimation and underestimation of PASP by TDE occurred in 15.7% (16/102) and 43.1% (44/102) respectively. The magnitude of pressure underestimation and overestimation was insignificant [(25 ± 12) vs (26 ± 16) mm Hg, P = 0.765]. The probability of underestimate was higher than that of overestimate. As to the corresponding diagnostic categories of severity that each subject would fall into for each technique, the diagnostic categories of 16 overestimated patients were in accordance. Among 44 underestimated patients, 9 (20.5%) had their pressure underestimated within one diagnostic category (minor error) while 2 (4.5%) were within two diagnostic categories (major error)., Conclusion: Due to a frequent rate of inaccurate estimation of PASP, TDE can not replace right heart catheterization. TDE tends to underestimate PASP and results in a diagnostic misclassification of degree.

Objective: To compare the effects of gabapentin on high-voltage-activated calcium (HVA) current in dorsal root ganglion (DRG) neurons in normal and nerve-injured rats and understand the reasons of their differences., Methods: Pathogen-free male SD rats (weight 180 - 220 mg) aged 4 - 6 weeks were used. The animals were anesthetized with intraperitoneal pentobarbital sodium 50 mg/kg. L(5) spinal nerve was ligated between DRG and sciatic nerve and cut distal to the ligature. The animals were decapitated at Day 14 post-operation. L(5) (SNL-L(5) group) and L(4) DRGs (SNL-L(4) group) were respectively isolated and the ganglionic neurons enzymatically dissociated. The control group of rats was not operated. The lumbar DRG neurons of normal rats were treated similarly. The HVA-Ca(2+) current was recorded by the technique of whole cell patch clamp., Results: Compared with the SNL-L(4) group [(16.0 ± 1.9)%, (26.9 ± 2.0)%, (27.4 ± 2.3)%] and the control group, gabapentin inhibited the peak calcium current highlier at 10, 100 and 300 µmol/L in the SNL-L(5) group [(18.5 ± 1.7)%, (32.0 ± 2.6)%, (32.7 ± 2.8)%] (P < 0.05). The steady-state inactivation curves shifted to more hyperpolarized potentials in the SNL-L(5) group. The N-type relative contribution to the gabapentin-sensitive HVA-Ca(2+) current was markedly elevated in the SNL-L(5) group compared with that in other two groups (P < 0.05)., Conclusion: Gabapentin enhances the inhibition of HVA-Ca(2+) current in injured DRG neurons following spinal nerve ligation in rats. The alteration in the activation of electrophysiological properties and the increase of N-type relative contribution to the total HVA-Ca(2+) current may be involved in the mechanism.

Objective: To explore the application of intracranial electrodes (IE) for temporal lobe epilepsy (TLE) surgery and assess the clinical utility of intracranial video electroencephalography (IVEEG)., Methods: The clinical data of 60 TLE patients undergoing implantation of IE were reviewed retrospectively. Cortical subdural strip, grids and depth electrodes were implanted by sphenotresia, bone disc craniotomy or stereotactic technology., Results: The implanted electrodes were as follows: frontal-temporal lobe cortical strip (n = 34), frontal-anterior temporal-occipitotemporal lobe cortical strip (n = 7), bilateral temporal lobe cortical strip (n = 7), combined temporal lobe strip & depth (n = 7), anterior temporal-occipitotemporal junction cortical strip (n = 3) and combined strip & grid (n = 2). The following procedures were performed: anterior temporal lobectomy (ATL) (n = 50), combined ATL & frontal focal cortical resection (n = 7), combined ATL & callosotomy (n = 1) and combined neocortex epileptogenic focus resection & amygdalohippocampectomy (n = 2)., Conclusion: IVEEG is effective and important for the localization of epileptogenic focus in patients with intractable temporal lobe epilepsy.

Objective: To analyze the status of dietary sodium intake of 18 - 65 years old Chinese people in nine provinces (autonomous region) in 1991 and 2006., Methods: In 1991 and 2006, China Health and Nutrition Survey was carried out in nine provinces, including Liaoning, Heilongjiang, Shandong, Jiangsu, Henan, Hunan, Hubei, Guangxi and Guizhou, Subjects were selected by multi-stage stratified cluster random sampling method from 18 - 65 years old people and 8235 subjects in 1991 and 7788 subjects in 2006. Sodium intake analysis was conducted across gender, regions and rural(urban) residences., Results: On average, sodium intake decreased from (6750.6 ± 3771.5) mg/d in 1991 to (4949.7 ± 2829.4) mg/d in 2006 (Z = -35.5, P < 0.01) among the 18 - 65 years old people. In 1991 and 2006, the main sources of dietary sodium were salt, soy sauce and vegetable. In 1991, the proportion were 79.6% ((5375.6 ± 3532) mg/d), 8.7% ((586.7 ± 721.7) mg/d) and 7.5% ((506.9 ± 906.1) mg/d), respectively. In 2006, the proportion were 71.5% ((3539.8 ± 2545) mg/d), 8.3% ((410.7 ± 547.9) mg/d) and 6.2% ((304.6 ± 610.7) mg/d), respectively., Conclusions: Among 18 - 65 years old residents, sodium intake in 2006 was significantly lower than that in 1991, but still far beyond the 2200 mg/d of adequate intake level (2200 mg/d). The major source of sodium intake in Chinese diet was condiments.

Objective: To analyze the trends of food consumption among Chinese residents aged from 18 to 59 years old in 9 provinces (autonomous region) from 1989 to 2006., Methods: The paper was based on data collected in 1991, 1993, 1997, 2000, 2004 and 2006 China Health and Nutrition Survey of Chinese residents of 24 h in three consecutive day dietary recall data. The healthy residents aged 18 - 59 years with twenty-four-hour dietary recall data were selected as study subjects. The sample sizes of these seven surveys were 5766, 7296, 7019, 7599, 8143, 7168 and 6827, respectively. The trends of their food consumption in each year were analyzed through Kruskal-wallis method., Results: The intake of cereals decreased significantly from (528.5 ± 192.9) g/d in 1989 to (427.7 ± 173.8) g/d in 2006 (χ(2) = 2833.13, P < 0.01). The minor variation of soybean food intake was observed. The average intake was (22.3 ± 39.4) g/d in 1989 and (18.9 ± 30.5) g/d in 2006 which was still at a low level. The trend of vegetables intake showed a small decrease. It was (374.5 ± 205.9) g/d in males and (346.4 ± 187.6) g/d in females in 2006, respectively. Both quantity and rate of fruits consumption showed an increase trend. Its consumption rate reached at 22.5% (741/3296) in males and 27.7% (1004/3619) in females in 2006, respectively. The average intake increased from (122.4 ± 126.9) g/d in 1989 to (228.5 ± 267.3) g/d in 2006 (χ(2) = 539.66, P < 0.01). At the same time, the daily intake of meat and egg showed a large increase, the average meat intake increased from (97.0 ± 111.5) g/d in males and (80.2 ± 97.0) g/d in females in 1989 to (141.5 ± 125.2) g/d in males and (118.4 ± 111.8) g/d in females in 2006, respectively. The oil consumption showed a significant increase. The average intake increased from (30.4 ± 37.9) g/d in 1989 to (42.8 ± 32.3) g/d in 2006 (χ(2) = 1646.94, P < 0.01)., Conclusions: There have been noticeable changes in the Chinese dietary pattern in the past 17 years. Some changes would be helpful for nutritional improvement in Chinese people, but it also caused some adverse effects on health because of improper food consumption.

Objective: To analyze the status and trend of dietary fiber intake and its food sources among Chinese residents aged 18 - 45 years old in 9 provinces (autonomous region), from 1989 to 2006., Methods: Twenty-four-hour dietary recall data of three consecutive days from China Health and Nutrition Survey (1989, 1991, 1993, 1997, 2000, 2004 and 2006) were used. And the 18 - 45 years old subjects with complete information on dietary survey were included. The sample size of these 7 surveys were 5597, 5596, 5323, 5485, 5308, 4144 and 3889, respectively. The trends of dietary fiber intake and food sources by time and sex were studied., Results: From 1989 to 2000, the total of daily dietary fiber intake of 18 - 45 years old healthy residents decreased from 15.1 g/d to 11.6 g/d, insoluble dietary fiber intake decreased from 22.6 g/d to 17.8 g/d. In villages, from 1989 to 2000, the insoluble dietary fiber intake decreased 5.1 g/d in males and 5.2 g/d in females(13.2, 11.8 g in 2000, respectively;18.3, 17.0 g in 1989, respectively). In 2006, the insoluble dietary intake was 12.6 g/d in males and 11.2 g/d in females in villages. In cities, from 1989 to 2006, the insoluble dietary fiber intake was 9.4 - 11.8 g/d in males and 8.3 - 10.8 g/d in females. The total dietary fiber intake was 15.7 - 17.6 g/d in males and 13.5 - 16.4 g/d in females. The difference of insoluble and total dietary fiber intake between city and village was decreasing. In 2006, 70.6% (8.4/11.9) insoluble dietary fiber came from vegetables ((4.1 ± 3.1) g/d), wheat flour and its products ((2.6 ± 3.6) g/d), rice and its products ((1.7 ± 1.3) g/d)., Conclusion: Dietary fiber intake among Chinese aged 18 - 45 in 9 provinces (autonomous region) decreased from 1989 to 2006. Vegetables, wheat flour, rice and their products were the major food sources of insoluble dietary fiber.

Objective: To investigate the relationship between genetic polymorphism in microRNAs (miRNAs) precursor and genetic predisposition of hepatocellular carcinoma (HCC) in Chinese population., Methods: A case-control study including 963 HCC cases and 829 HBsAg positive controls and 852 HBsAg negative controls was conducted. hsa-mir-146a rs2910164 C→G and hsa-mir-196-a2 rs11614913 T→C were selected, where the genotypes were determined by the primer introduced restriction analysis-PCR (PIRA-PCR) assay. Odd ratios (ORs) and 95% confidence intervals (CIs) were evaluated by logistic regression analysis to investigate the relationship between onset risk of HCC and different genotypes., Results: The genotype frequencies of CC, CG and GG at rs2910164 gene locus were separately 34.5% (319/925), 48.6% (450/925) and 16.9% (156/925) in cases; 36.4% (274/753), 45.0% (339/753) and 18.6% (140/753) in HBsAg positive controls; and 36.1% (303/840), 46.0% (386/840) and 18.0% (151/840) in HBsAg negative controls. The genotype frequencies of TT, CT and CC at rs11614913 were respectively 29.7% (277/934), 48.1% (449/934) and 22.3% (208/934) in cases; 30.3% (238/785), 51.0% (400/785) and 18.7% (147/785) in HBsAg positive controls; and 28.6% (239/837), 49.8% (417/837) and 21.6% (181/837) in HBsAg negative controls. No significant relationships were observed between these two single nucleotide polymorphisms (SNPs) and onset risk of HCC after adjusting the factors as age, gender, smoking and drinking status in comparison with HBsAg positive controls: hsa-mir-146a rs2910164 (CG + GG vs CC): adjusting OR = 1.10, 95%CI: 0.90 - 1.36; hsa-mir-196-a2 rs11614913 (CC + CT vs TT): adjusting OR = 1.01, 95%CI: 0.81 - 1.25; as well as in comparison with HBsAg negative controls: hsa-mir-146a rs2910164 (CG + GG vs CC): adjusting OR = 1.06, 95%CI: 0.87 - 1.29; hsa-mir-196-a2 rs11614913 (CC + CT vs TT): adjusting OR = 0.94, 95%CI: 0.76 - 1.16. As well, no significant relationships were observed between these two SNPs and onset risk of HCC in the subgroups stratified by age, gender, smoking and drinking status., Conclusion: hsa-mir-146a rs2910164 C→G and hsa-mir-196-a2 rs11614913 T→C may not play an important role in the HCC predisposition among Chinese populations.

Objective: To evaluate short-term and long-term safety of using single-dose escalation of recombinant humanized anti-CD3 monoclonal antibody (OKT3) in kidney transplantation recipients., Methods: A total of 29 recipients of cadaveric kidney transplant from June 2008 to December 2008 were sequently assigned to receive single-dose intravenous injection of OKT3 with different doses of 2.5 mg (n = 9), 5.0 mg (n = 10) and 10.0 mg (n = 10) at Days 7 - 14 post-operation. Meanwhile, a control group was established by selecting kidney transplant recipients, who did not participate in the trial in the same period. All patients were followed up for at least 2 years. During this period, liver function, kidney function, hemoglobin and other biochemical indicators were monitored and adverse events recorded over time., Results: No obvious first dose effect was observed, except low heat (7/29), chills (4/29), mild liver damage (2/29), upper respiratory tract infection and headache (1/29) across all doses. Other adverse reactions were mild, unrelated with doses. The 2-year patients/grafts survival rates of treatment group and control group were 100%/100%, and 100%/97%, respectively. The incidence of acute rejection confirmed by renal biopsy was 6.9% (2/29) and 10.0% (3/30) in treatment group and control group, respectively. The incidence of lung infection was 10.3% (3/29) and 13.3% (4/30), respectively. The values of serum creatinine at 1 week and 3, 6, 12, 24 months showed no statistically significance in two groups (all P > 0.05)., Conclusion: It is safe to use single-shot OKT3 intravenously in kidney transplant recipients. The recombinant humanized OKT3 may be an effective immunosuppressive agent with milder toxicity for solid organ transplantation.

Objective: To improve the recolonization of long term interval between optic neuropathy and spinal cord injury of neuromyelitis optica., Methods: One 51-year old male patient with 37 years' interval between optic neuropathy and spinal cord injury of neuromyelitis optica underwent the examination of plasma and cerebrospinal fluid and head and spinal MRI examinations, who was also followed up. His clinical data were analyzed and related literature was reviewed., Results: The myelin basic protein and IgG index in his cerebrospinal fluid was high, his oligoclonal band of cerebrospinal fluid was positive, and abnormal finding in visual evoked potential. Abnormal intramedullary long T(2) signals was showed in spinal cord MRI at T(1-7) segment. When diagnosed as neuromyelitis optica, the clinical symptom and signs was improved with corticosteroid and gamma globulin therapy. The patient was in stable condition at present., Conclusions: There could be a long term interval between optic neuritis and myelitis. One should pay attention to clinical features and imaging examination of subclinical lesion in spinal cord and brain and conoid the possibility of developing neuromyelitis optica or multiple sclerosis.

Objective: Sildenafil has been shown to be effective in pulmonary arterial hypertension (PAH). However, the impact of sildenafil on PAH has been under-investigated in China. The aim of the present study was to evaluate the efficacy and safety of oral sildenafil in PAH patients in China., Methods: In this prospective, open-label and multi-center study, 90 patients were recruited from 14 centers to receive oral sildenafil (75 mg/d) for 12 weeks. They underwent a six-minute walk test (SMWT) and cardiac catheterization at the beginning and the end of 12 weeks. The primary endpoint was the changes in exercise capacity as assessed by SMWT. And the secondary endpoints included assessment of functional class, evaluation of cardiopulmonary hemodynamics and clinical deterioration (defined as death, transplantation and re-hospitalization for PAH). Drug safety and tolerability were also examined., Results: There were 19 males and 71 females with an average age of 32.5 ± 12.1 years old (range: 18 - 61). Their etiologies were idiopathic (n = 15), related with congenital heart disease (n = 60), or related with connective tissue disease (n = 9) and chronic thromboembolic pulmonary hypertension (n = 6). Oral sildenafil significantly increased the SMWT distances [(342 ± 93) m vs. (403 ± 88) m, P < 0.001]. There was also remarkable improvement in Borg dyspnea score (2.9 ± 2.6 vs. 2.4 ± 2.0, P = 0.005). Furthermore, significant improvements in World Healthy Organization (WHO) functional class and cardiopulmonary hemodynamics were also found (mean pulmonary artery pressure, P < 0.001; cardiac index, P < 0.001; pulmonary vascular resistance, P < 0.001). Side effects were mild and consistent with other reports., Conclusion: This study confirms and extends previous studies. Oral sildenafil is both safe and effective for the treatment of adult PAH patients in China.

Objective: To investigate the clinical manifestations of patients with pulmonary artery hypertension (PAH) associated with hereditary hemorrhagic telangiectasia (HHT)., Methods: This retrospective analysis summarized the clinical features of 6 patients with PAH associated with HHT hospitalized at department of cardiology in Cardiovascular Institute and Fuwai Hospital between January 2006 and May 2009., Results: The mean age of the 6 patients (3 male) was 34 years (8 - 67 years). Recurrent epistaxis were present in all patients, there were 4 patients with severe PAH and 2 patients with moderate PAH. All of the six patients with PAH associated with HHT were misdiagnosed at the first hospital visit. Clinical symptoms were significantly improved in 4 patients and remained unchanged in 2 patients combined hepatic venous malformation post medical therapy., Conclusions: Misdiagnosis for patients with PAH associated with HHT is a common phenomenon in daily clinical practice. Patients could benefit from the corresponding medical therapy after the establishment of the correct diagnosis.

Objective: to evaluate the outcome of surgical treatment for spinal deformity in patients with achondroplasia., Methods: six consecutive cases of 3 males and 3 females were recruited. The average age at surgery was 18.5 years old with a range of 12 to 36 years old. All patients suffered thoracolumbar kyphosis and lumbar stenosis. Four patients had neurological deficits due to severe spinal deformity. Posterior osteotomy and decompression were performed in all cases. Long cassette supine radiographs were taken before and after surgery and at the final follow-up. Correction of kyphosis, neurological outcomes (JOA (Japanese Orthopedic Association) scores) and operative complications were recorded and analyzed., Results: the average follow-up was 10.2 months with a range of 5 to 24 months. The average operative duration was 320 min with a mean 1300 ml of blood loss. The average number of fusion segments was 8 with a range of 5 to 10 segments. Kyphosis was corrected from 53.3° to 13.3° with a 75.0% correction rate. The average preoperative JOA score was 4.5 points and improved to 8.5 points at the final follow-up., Conclusion: posterior osteotomy and decompression is a preferred surgical regiment for thoracolumbar kyphosis and lumbar stenosis in patients with achondroplasia.

Objective: To summarize the clinical features, neuroimaging findings and pathological characteristics of 26 patients with tumor-like inflammatory demyelinating diseases (TIDD) confirmed by histopathology for better diagnosis and differential diagnosis., Methods: The clinical features, neuroimaging findings and pathological characteristics of 26 patients (14 male, 12 female) with pathologically proven TIDD (24 brain-type and 2 spinal cord-type) were retrospectively analysed., Results: The mean onset age was 6 - 69 (36.7 ± 13.8) years. Twenty-one patients had good prognosis with a median followed-up duration of 51.0 months. Two patients were died of post-operative complication and pulmonary infection respectively and the remaining 3 patients were lost to followed up. The TIDD patients almost showed monophasic clinical setting. Headache, indifference accompanied with hypothesis were the commonest initial symptoms. The positive or abnormal rates of cerebrospinal fluid oligoclonal bands (OCB) and myelin basic protein (MBP) in TIDD patients were high. The involvements of bilateral and multi-lesions were commonest in TIDD (61.5%, 65.4% respectively). Twenty-two patients with CT unenhanced scanning showed hypodense lesions. Long T(1) and long T(2) signal intensity was showed on MRI and most cases appeared round-like lesion in shape. According to the shape of enhancement of the 23 patients performed with contrast agents, 11 were shown with open-ring enhancement, 4 cases (including 2 accompanied with open-ring enhancement) with complete ring enhancement, 3 with asymmetrical dotted enhancement, 2 with diffused even enhancement, and no enhancement was seen in the other 6. Furthermore, 14 cases with DWI and 12 with FLAIR all appeared hyperdensity. The typical pathological changes were demyelinating, perivascular inflammatory cells infiltration and reactive gliosis. Occasionally, the Creutzfeldt cells were also found in brain tissue of some patients., Conclusions: TIDD is a distinct demyelinating disease entity. In spite of being apt to be confused with the neoplasm in brain and spinal cord. TIDD has its own-features, for example, OCB is frequently positive in patients with TIDD and the level of MBP may be significantly increased. Furthermore, the involvements of bilateral and multi-lesions are the common in TIDD, and most cases showed open-ring enhancement or complete rim enhancement on MRI. In addition, all cases present hypodense lesions on unenhanced CT and patients with hyperdense seemed not to be considered as TIDD.