2010年 · 第123卷第06期

The prevalence of type 2 diabetes is rising at an alarming rate in China due to aging of the population,increased frequency of obesity, and suboptimal nutritional habits.~1 Although many diabetic Patients now survive severe coronary lesions or myocardial infarction as a result of dramatic advances in the management of ischemic heart disease in general and acute myocardial infarction specifically,~(2,3) they are subsequently succumbing to the consequences of myocardial damage, with an increased incidence of congestive heart failure (CHF).~4…… Foundation Item：This work was supported by key grants from Shahghai Science and Technology Foundation(No.05DZ19503)and Shen Kang Medical High-tech Foundation(No.SHDC 12007105)。

Abstract：Background Chronic heart failure(CHF)and diabetes mellitus portend high morbidity and mortality because of an interrelated pathophysiologic process.This large cohort study aimed to analyze the prevalence,clinicaI characteristics and long-term outcome of patients with CHF and diabetes.Methods A totaI of 1119 patients with NYHA functionaI class Ⅱ-Ⅳ and left ventricular ejection fraction(LVEF)<45% between January 1995 and May 2009 were recruited.Clinical variables, biochemical and echocardiographic measurements were retrospectively reviewed,and composite major cardiac events (MCE) including death,headtransplantation, and refractory heart failure requiring multiple hospitalizations were recorded.Results The prevalence of CHF with diabetes was progressively increased with time (16.9% in 1995-1999;20.4% in 2000-2004,and 29.1% in 2005-2009)and age(1 8.5% in<60 years,26.6% in 60-80 years,and 26.6% in>80 years).Compared with CHF patients without diabetes,those with diabetes had worse cardiac function,more abnormal biochemical changes.and higher mortality.Treatment with glucose-lowering agents significantly improved LVEF and decreased MCE.An elevated serum HbA1c level was associated with large left ventricular end-systolic diameter (P<0.05),decreased LVEF(P<0.01)and reduced survival(P＜0.05).Multivariable Logistic regression analysis revealed that after adjustment for confounding factors,NYHA functional class(OR2.65,95%CI 1.14-6.16,P=0.024)and HbA1c level≥7%(OR2.78, 95%CI 1.00-7.68,P=0.049)were independent risk factors for adverse outcomes in CHF patients with diabetes.Conclusions Prevalence of CHF with diabetes was increasing during past decades,and patients with CHF and diabetes had worse clinical profiles and prognosis.Aggressive anti-CHF and diabetes therapies are needed to improve overall outcomes for these patients。

Abstract：Background Doppler color echocardiography is a common method for detecting coronary artery lesions in patients with Kawasaki disease(KD).However,the diagnostic accuracy for the whole coronary artery lesions is limited.The purpose of this study was to compare the diagnostic value of dual-source computed tomography (DSCT) and Doppler color echocardiography for the assessment of coronary artery lesions caused by KD.Methods Sixteen patients,12 with typical KD and 4 with atypical KD,underwent DSCT and Doppler color echocardiography.The position and internal diameter of each coronary artery lesion was measured.Correlation analysis was used to compare the diagnostic value of the two imaging modalities.Results ln the typical KD group, seven patients did not have any coronary artery Iesion as confirmed by both DSCT scans and Doppler color echocardiography;in four patients proximal coronary artery injuries were identified by both modalities;in one patient an aneurysm in the middle and distal segments of the coronary artery was detected by DSCT but was negative in Doppler color echocardiography.In the atypical KD group,three cases showed the same results with both modalities,while one case with coronary artery stenosis in the middle segment was identified by DSCT but not detected by Doppler color echocardiography.There was a good correlation between the two imaging modalities(Kappa value,0.768(≥0.75)).Conclusion DSCT coronary artery angiography is an accurate,non-invasive,and valuable technique for detecting and following up coronary artery lesions in patients with KD。

Abstract：Background Post-traumatic kyphosis is a common potential complication of spinal trauma and correct management of this problem is becoming ever more impcrtant.Although posterior vertebra column resection has been increasingly adopted to correct severe spinal deformity,no series of reports were found on severe post-traumatic kyphosis in the thoracolumbar region.Therefore,the present cohort retrospective study is presented to evaluate the clinical and radiographic results of posterior vertebra column resection with instrument fusion performed in patients with severe post-traumatic kyphosis.Methods From May 2004 to May 2006,53 patients(38 male,1 5 female)at an average age of 37.6 years(range,24 to 66 years),were surgically treated for symptomatic post-traumatic thoracolumbar kyphosis with a posterior wedge closing osteotomy at our hospital.Among them,5 consecutive adult patients with severe post-traumatic kyphosis were included in this study.Operation time, blood lOSS and complications were noted in each case.Radiographic documentation was made on the basis of standing anterior-posterior(AP)and lateral views and three dimensional reconstruction images of computed tomography (CT) scans were used to further identify the apex region of a sharp angular deformity.Sagittal correction was assessed in terms of effective regional deformity(ERD)for the injury Ievel.Assessment of radiological fusion at follow-up was based on the presence of trabecular bone bridging at the osteotomy site according to Brantigan.Preoperative and postoperative clinical assessments were performed by using Oswestw disability index(ODI), back pain was rated in all patients by the visual analog scale (VAS) preoperatively,postoperatively and at the latest follow-up.Results The mean operating time was 265 minutes(220-408 minutes),with an average blood loss of 1 362 ml (870-2570 m1).Each patient finished at least two years of follow-up.The average ERD significantly decreased from 69°(58°-86°),preoperatively to 4°(1°-8°) after surgery (P=0.01 7);with a mean correction of 65°.ERD averaged 1 0.4°(7°-1 7°)at the latest follow-up with a mean loss of 6.4°.VAS and ODI scores improved from preoperative 7.4(6.0-9.0) and 55.2(48.0-60.0) to 2.3(1.0-4.0) and 1 2.2(7.0-18.0)at the latest follow-up.Full bone fusion was achieved in all patients.Complications occurred in two patients:one had a transient weakness of the Ieft side lower extremity and the symptom improved spontaneously without further treatment within one month;the other patient suffered a deep wound infection three weeks after the operation,and recovered well by additional debridement,continuous perfusion and drainage.Conclusions Posterior vertebra column resection can satisfactorily correct severe post-traumatic kyphosis in thoracolumbar region.Nevertheless,this challenging procedure should be performed by experienced spinal surgeon to minimize complications。

Abstract：Background Image-guided core-needle biopsy as a minimally invasive procedure has partially replaced excisional biopsy of the lymph node. However, it is still a great challenge to pathologists. The aim of this study was to survey and evaluate the accuracy of pathological diagnosis using the ultrasonography (US)-guided core-needle biopsy (CNB) of the lymph node.Methods Lymph node CNBs of 1119 consecutive patients from the Chinese People's Liberation Army (PLA) General Hospital were reviewed retrospectively. Biopsies were performed following outpatient procedures with direct US guiding by using 18-gauge cutting needle. The tissues of CNB were prepared according to the routine paraffin embedding and hematoxylin-eosin staining. Ancillary studies, including acid-fast staining and immunohistochemical staining, were performed when necessary.Results The age range was 1 year old to 85 years old. Locations of the lymph node were as follows: cervical area (n=482), clavicular region (n=-227), retroperitoneum (n=-150), axilla (n=93), groin (n=79), abdomen/mesentery (n=44),submaxillary region (n=-33), postauricular region (n=4), iliac rosa (n=3), parotid (n=2), hepatic hilar region (n=1), and elbow (n=1). The histological diagnoses were conclusive in 815 cases (73%) and inconclusive in 304 cases (27%). The conclusive cases mainly included metastatic carcinoma (n=-449), tuberculosis (n=111), lymphoma/leukemia (n=124), reactive hyperplasia (n=-87), and other rare diseases (n=44). The reasons for inconclusive cases were insufficient material for diagnosis, noncompliance of outpatients, or crushing artifacts of tissues caused by operation.Conclusions US-guided CNB can obtain lymphoid tissues from nearly all parts of the body for diagnostic purposes.Conclusive pathological diagnosis can be made in most of cases when adequate material was provided. Besides metastatic carcinoma,lymphomas with special immunophenotype can be accurately diagnosed and subclassified by US-guided CNB。

Abstract：Background Although thalamotomy could dramatically improve both parkinsonian resting tremor and essential tremor (ET), the mechanisms are obviously different. This study aimed to investigate the neuronal activities in the ventrolateral thalamus of Parkinson's disease (PD) and ET. Methods Thirty-six patients (PD: 20, ET: 16) were studied. Microelectrode recordings in the ventral oral posterior (Vop)and the ventral intermediate nucleus (Vim) of thalamus was performed on these patients who underwent thalamotomy.Electromyography (EMG) was recorded simultaneously on the contralateral limbs to surgery. Single unit analysis and the interspike intervals (ISIs) were measured for each neuronal type. ISI histogram and auto-correlograms were constructed to estimate the pattern of neuronal firing. Mann-Whitney test and Kruskal-Wallis (K-W) test were used to compare the mean spontaneous firing rate (MSFR) of neurons of PD and ET patients. Results Three hundred and twenty-three neurons were obtained from 20 PD trajectories, including 151 (46.7%) tremor related neuronal activity, 74 neurons (22.9%) with tonic firing, and 98 (30.4%) neurons with irregular discharge. One hundred and eighty-seven neurons were identified from 16 ET trajectories including 46 (24.6%) tremor-related neuronal activity, 77 (41.2%) neurons with tonic firing, and 64 neurons (34.2%) with irregular discharge. The analysis of MSFR of neurons with tonic firing was 26.7 (3.4-68.3) Hz (n=74) and that of neurons with irregular discharge (n=98) was 13.9 (3.0-58.1) Hz in PD; whereas MSFR of neurons with tonic firing (n=77) was 48.8 (19.0-135.5) Hz and that of neurons with irregular discharge (n=64) was 26.3 (8.7-84.7) Hz in ET. There were significant differences in the MSFR of two types of neuron for PD and ET (K-W test, both P<0.05). Significant differences in the MSFR of neuron were also obtained from Vop and Vim of PD and ET (16.3 Hz vs. 34.8 Hz, 28.0 Hz vs. 49.9 Hz) (K-W test, both P <0.05), respectively. Conclusion In consistent with recent findings, the decreased MSFR of neurons observed in the Vop is likely to be involved in PD whereas the increased MSFR of neurons seen in the Vim may be a cause of ET。

Abstract：Background Previous studies demonstrated general anesthetics affect potassium ion channels, which may be one of the mechanisms of general anesthesia. Because the effect of etomidate on potassium channels in rat hippocampus which is involved in memory function has not been studied, we investigated the effects of etomidate on both delayed rectifier potassium current (I_((K(DR))) and transient outward potassium current (I_((K(A))) in acutely dissociated rat hippocampal pyramidal neurons.Methods Single rat hippocampal pyramidal neurons from male Wistar rats of 7-10 days were acutely dissociated by enzymatic digestion and mechanical dispersion according to the methods of Kay and Wong with slight modification. Voltage-clamp recordings were performed in the whole-cell patch clamp configuration. Currents were recorded with a List EPC-10 amplifier and data were stored in a computer using Pulse 8.5. Student's paired two-tail t test was used for data analysis. Results At the concentration of 100 μmol/L, etomidate significantly inhibited I_(K(DR)) by 49.2% at +40 mV when depolarized from -110 mV (P <0.01, n=8), while did not affect I_(K(A)) (/1=8, P >0.05). The IC_(50) value of etomidate for blocking I_(K(DR)) was calculated as 5.4 μmol/L, with a Hill slope of 2.45. At the presence of 10 μmol/L etomidate, the V_(1/2) of activation curve was shifted from (17.3±1.5) mV to (10.7±9.9) mV (n=8, P <0.05), the V_(1/2) of inactivation curve was shifted from (-18.3±2.2) mV to (-45.3±9.4) mV (n=8, P <0.05). Etomidate 10 μmol/L shifted both the activation curve and inactivation curve of I_(K(DR)) to negative potential, but mainly affected the inactivation kinetics.Conclusions Etomidate potently inhibited I_(K(DR)) but not I_(K(A)) in rat hippocampal pyramidal neurons. I_(K(DR)) was inhibited by etomidate in a concentration-dependent manner, while I_(K(A)) remained unaffected。

Abstract：Background Early and late-onset preeclampsia is thought to be different disease entities. This study aimed to determine the effects of early-onset preeclampsia-like symptoms on feto-placental outcomes and the adverse impacts of various factors on placental and fetal growth and development at different gestational stages in a mouse model. Methods Pregnant C57BL/6J mice were divided into control and preeclampsia (PE) groups, and injected subcutaneously with the nitric oxide synthase inhibitor L-arginine methyl ester (L-NAME) 50 mg·kg~(-1)·d~(-1). The PE group was divided into early-, mid- and late-PE groups with L-NAME injections starting on days 7, 11 and 16 of pregnancy, respectively. Corresponding control groups were injected with saline at the same time points. Blood pressure was measured until days 14 and 18, when the fetuses and placentas were removed under anesthesia. Blood pressure, urinary protein, and fetal and placental conditions were analyzed. Results Blood pressure and urinary protein increased following L-NAME injection. The fetal survival rate and fetal weight were reduced and the fetal absorption rate was increased in the early-PE group on days 14 and 18 of pregnancy, compared with the control group. There were no significant differences in these parameters between the late-PE group and the respective control group. Placental weights in the early- and mid-PE groups were significantly reduced at days 14 and 18 of pregnancy compared with the control groups, but there was no significant difference in placental weight between the late-PE group and the respective control group. Morphologic examination of placentas from the early- and mid-PE groups showed varying degrees of fibrinoid necrosis and villous interstitial edema, but no significant pathologic changes were found in the placentas from the late-PE or control groups. Conclusion Preeclampsia-like symptoms occurring during the early stage of pregnancy are more likely to affect placental and fetal development, whereas late onset preeclampsia-like symptoms have a direct impact on the mothers.

Abstract：Background Choroidal neovascularization (CNV) is a common cause of visual loss in the elderly patients with age-related macular degeneration and represents the growth of subretinal new vessels in the macular region. This study aimed to investigate the relationship between annexin A2 (ANXA2) and vascular endothelial growth factor (VEGF) in CNV.Methods In a rat model of argon laser coagulation-induced CNV, the mRNA expressions of the annexins and VEGF protein expression in the retina were detected using fluorescent real-time polymerase chain reaction (PCR) and immunohistochemistry, respectively. The interactions between ANXA2 and VEGF in both a retinal pigment epithelial cell line RPE-J and the rat model of CNV were examined by means of RNA interference, real-time PCR, Western blotting, enzyme-linked immunosorbent assay (ELISA) and histopathological examinations. Results Fundus fluorescein angiography (FFA) showed that argon laser coagulation of the retina induced stable CNV models in the rats. Two to three weeks after the coagulation, ANXA2. and VEGF expressions in the coagulated area in the retina and choroid increased to the peak level, while the other annexin members (ANXA4, ANXA5, ANXA7 and ANXA11) showed no obvious changes. In RPE-J cells and the CNV model, RNA interference of ANXA2 gene significantly lowered the VEGF protein and mRNA expressions, and application of an adenoviral vector containing ANXA2 gene markedly increased VEGF expressions in the rat model of CNV, but produced no significant effects on the expressions of the kinase insert domain-containing receptor (KDR) or the fms-like tyrosine kinase (Fit-l). The expression of KDR inhibited the increment in ANXA2 expression, but VEGF and Rt-1 did not directly affect ANXA2 expression. Conclusion Besides the role as a plasminogen and the receptor of tissue plasminogen activator, ANXA2, which is under regulation of KDR via a negative feedback mechanism, also participates in neovascularization by regulating VEGF expression through a positive feedback mechanism。

Abstract：Background Hyperglycemia in brain and spinal cord could aggravate neurologic impairment. Recent studies showed that L-lysine monohydrochlonde (LMH) could increase the insulin secretion and regulate the blood glucose level. The aim of the present study was to investigate the effects of LMH on pancreatic islet B cells, the levels of endogenous insulin and blood glucose in spinal cord injured rats.Methods Forty male Wistar rats were divided into four groups, namely, normal control group, model group, high-dose LMH group (621.5 mg/kg equal to LMH 1/8 LD50), and low-dose LMH group (310.8 mg/kg equal to LMH 1/16 LD50). The model of spinal cord injured rat was established by hemi-transection at the lower right thoracic spinal cord. LMH was administered via intraperitoneal injection once spinal cord injury was produced in rats. All rats were sacrificed 48 hours after spinal cord injured. The effects of LMH on pancreatic islet B cells, the content of endogenous insulin, end the level of blood glucose were observed with immunohistochemical method, radioimmunoassay method, end biochemical analyzer, respectively. Results The insulin immunohistochemical intensities of islet B cells were significantly weaker in model group then those in normal control group (P <0.01). The levels of endogenous insulin were significantly lower and the blood glucose levels were significantly higher in model group than those in normal control group (P <0.01). The insulin immunohistochemical intensities of islet B cells were significantly stronger in high-dose LMH group then those in model group (P<0.05). In addition, we found that the levels of endogenous insulin were significantly higher and the blood glucose levels were significantly lower in high-dose LMH group then those in model group (P <0.05). There were no significant differences in the insulin immunohistochemical intensities of islet B cells, the levels of endogenous insulin and the blood glucose between low-dose LMH group and model group (P >0.05). Conclusion LMH, but dose-dependent, might participate in the regulation of pancreatic islet B cells, and then reduce the blood glucose levels in the spinal cord injured rats。

Abstract：Background Liver fibrosis is the process through which numerous chronic liver diseases develop into liver cirrhosis. Leptin can activate hepatic stellate cells (HSCs) and play an important role in the formation of liver fibrosis. However, the process by which leptin activates HSCs is complicated, and research on this process is limited. The aim of this study was to explore the related changes in gene expression and the control mechanisms involved in leptin activated HSCs to understand the overall mechanism of liver fibrosis development. Methods We cultivate rat HSCs, with and without stimulation by leptin, and extracted mRNA. Differentially expressed genes were detected by microarray analysis. Results The differentially expressed genes identified included six upregulated genes and six downregulated genes. The representative upregulated genes included short chain dehydrogenase (CY5/CY3=2.265) and pulmonary surfactant protein A1 (CY5/CY3=2.036). The significant downregulated gene encoded hepatic stearoyl coenzyme A desaturase 1 (SCD-1) (CY5/CY3=0.351).Conclusion Leptin might mediate the molecular biological mechanisms of liver fibrosis。

Abstract：Background Insulin resistance(IR)is significantly associated with coronary artery disease and cardiovascular events in patients with or without type 2 diabetes mellitus.This study aimed to evaluate the influence of IR on long-term outcomes of patients undergoing percutaneous coronary intervention(PCI)with sirolimus-eluting stent(SES)implantation.Methods A total of 467 consecutive patients undergoing SES-based PCI were divided into lR group(n=104)and non-IR group(n=363).The patients were followed up for one year.The rate of major adverse cardiac events(MACEs) including death, non-fatal myocardial infarction and recurrent angina pectoris was compared by the log-rank test,and the independent risk factors were identified by the Cox regression analysis.Results MACEs occurred more frequently,and cumulative survival rate was lower in the IR group than in the non-IR group during the follow-up (all P<0.05).IR was an independent risk factor for the occurrence of cardiac death and non-fatal myocardial infarction(OR=2176,95% CI=1.35-5.47,P=0.034).Old age,diabetes,and multi-vessel disease were determinants for recurrent angina pectoris after PCI(P<0.05).Subgroup analysis revealed that IR(OR=3.35,95% CI=1.07-13.59,P=0.013)and multi-vessel disease(OR=2.19,95%CI=1.01-5.14,P=0.044)were independent risk predictors for recurrent angina pectoris in patients with diabetes after PCI.Conclusions IR is associated with reduced MACE-free survival and remains an independent predictor for recurrent angina pectoris after PCI with SES implantation。

Abstract：Background High-density lipoprotein cholesterol(HDL-C)levels are a strong,independent inverse predictor of coronary heart disease (CHD).In this cross-sectional study we investigated the interrelationships between HDL-C and HDL relaled factors apolipoprotein A-I(apoA-I)and serum amyloid A(SAA)and the presence and extent of CHD in a population of Chinese patients with CHD. Methods Two hundred and twenty-four consecutive patients took part in this study.Demographic data were obtained from hospital records.Serum chemical concentrations were measured by standard laboratory methods.Reaults The concentrations of high-sensitive C-reactive protein(hsCRP)(median:1.85 mg/L)and SAP,(median:9.40 mg/L)were significantly higher in the CHD group(P<0.05),while concentrations of HDL-C(0.03±0.25)mmol/L)and apoA-I((604.59±1 05.79)mmol/L)were significantly lower than those in the non-CHD group(P<0.05).The concentrations of apoA-l decreased with the increase in vascular damage.but the difference did not reach statistical significance.However, the concentrations of hsCRP and SAA increased with the increase in vascular damage.The unadjusted odd ratios(ORs)(CI) for apoA-I and SAA of the presence of CHD were 0.093(0.990-0.997)(P=0.00)and 2.571(1.029-6.424)(P<0.05),respectively.The association between elevated SAA and the presence of CHD was lost after adjusting for lipid status parameter concentrations.The associations between apoA-I.SAA and the extent of CHD remained strong,regardless of confounding variables.Conclusions Increased concentrations of SAA represent the inflammatory marker of the extent of coronary stenosis in patients with CHD.In contrast to SAA, the level of apoA-I was also associated with the presence of CHD, indicating that apoA-I was not only a marker of CHD presence but also a quantitative indicator of CHD extent.In short.determining the change apolipoprotein content within HDL particle is a more accurate and effective method to evaluate the impact of HDL on CHD。

Abstract：Background Prior research about N400 has been mainly based on English stimuli,while the cognitive.processing of Chinese characters is still unclear.The aim of the present study was to further investigate the semantic processing of Chinese idioms.Methods Event related potentials (ERP) component N400 was elicited by 38 pairs of matching (congruent) and mismatching (incongruent) ended Chinese idioms:ending words with same phoneme but different shape and meaning (sPdSdM),with similar shape but different phoneme and meaning(sSdPdM),with same meaning but different phoneme and shape(sMdPdS),and words with different phoneme,shape and meaning(dPdSdM)and recorded by Guangzhou Runjie WJ-1 ERP instruments.In 62 right-handed healthy adults(age 19-50 years),N400 amplitudes and latencies were compared between matching and mismatching conditions at Fz,Cz and Pz.Results N400 showed a midline distribution and could be elicited in electrodes Fz, Cz and Pz.The mean values of N400 latencies and amplitudes were obtained for matching and mismatching ending werds in healthy adults.Significant differences were found in N400 latencies and amplitudes in matching and mismatching ending-werds idioms in healthy adults(P<0.05).Compared with matching ending-werds jdioms, N400 latencies were prolonged and the amplitudes were increased in mismatching ones.N400s elicited by different types of stimuli showed different latencies and amplitudes.and longest N400 latency and largest N400 amplitude were elicited by ending-werds with dPdSdM.No gender difference was found of N400 latency and amplitude in this study (P>0.05).Conclusions Compared with English stimuli.Chinese ideographic words could provide more flexible stimuli for N400 research in that the werds have 3-dimension changes-phoneme.shape and meaning.Features of N400 elicited by matching and mismatching ending words in Chinese idioms are mainly determined by the meaning of the werd.Some issues of N400 elicited by Chinese characters deserve further research。

Abstract：Background Cumulative evidence demonstrates that primary percutaneous coronary intervention(PCI)is a mperfusion strategy for ST-elevation myocardial Infarction(STEMI).This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system,which offers patients a choice between seeking care in a small community hospital(SH group)or a large hospital(LH group).Methods Between January 1 and December 31,2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.Results Among the 566 patients interviewed,28.3%first arnved at a small community hospitaI and were transferred to large hospitals with the ability to perform primary PCI.The median total pre-hospital delay in the SH group(n=160)was significantly longer than in the LH group(n=406)(225 vs.120 minutes,P<0.001).Multivariate analysis showed that interpreting symptoms to non-cardiac origin(OR,1.996;95%CI: 1.264-3.155),absence of history of myocardial infarction(OR,1.595;95%CI:1.086-3.347),non-health insuranca coverage(OR,1.931;95%Cl:1.079-3.012)and absence of sense of impending doom (OR,4.367;95%CI:1.279-1 4.925) were independent predictors for choosing small hospitals.After adjusting for demographics and medical history,patients in the SH group were 1.698 times(95% CI: 1.1 82-3.661) less likely to receive primary PCI compared with those in the LH group. Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer.Factors including symptoms interpretation,symptoms,history of myocardial infarcUon,and insurance coverage were associated with the patients'pre-hospital care-seeking pathway.The patients who were transferred had longer pre-hospital delays and were less Iikely to receive primary PCI。

Abstract：Background High fluoride exposure can result in dental fluorosis.Fluoride and iodine are coexistent in the drinking water of areas in China and may affect the prevalence of dental fluorosis and osteogenesis.The aim of this study was to investigate the relationship between serum calciotropic hormone level.and dentaI fluorisis in children exposed to different concentrations of fluoride and iodine in drinking water.Methods A pilot study was conducted in three villages located in the Kaifeng and Tongxu counties of Henan Province,China in 2006.Children aged 8 to 12 years.born and raised in the three villages were recruited.The fluoride levels in the samples of urine from these children were detected by fluoride ion selective electrode.Calcitonin and osteocalcin levels in the serum,and serum calcium were measured by radioimmunassay and flame atomic absorption spectrometry, respectively.Results Fluoride levels in urine were significantly lower in children from control area(CA)as compared with those from the high fluoride & iodine areas(HFIA)and the high fluoride area(HFA)(P<0.05 respectively),and no statistically significant difference was found between the children from HFIA and HFA.Additionally,calcitonin levels in the serum were significantly lower in children from CA and HFA as compared with that from HFIA(P<0.05 respectively),and osteocalcin levels in the serum was lower in children from CA than those from HFIA (P<0.05).No statistically significant difference in serum osteocalcin concentrations was found between children from HFA and HFIA.Conclusion This study provides an evidence that iodine exposure may modify the serum calciotropic hormone levels related to fluorine exposure。

Approximately 2/3 of cardiovascular diseases in the Asia-Pacific region are closely associated with hypertension.~1 And statistics indicates the existence of 160 million hypertension patients in China in 2004 with approximately 1 billion patients simultaneously suffering from other cardiovascular diseases.~2 It is evident that hypertension control plays a crucial role in the prevention of cardiovascular disease. This study aimed to find the epidemiological features of hypertension in Heilongjiang province and to gather statistical information about the prevalence and causative factors of hypertension.

Uterine mullerian adenosareoma is a very rate tumor clinically. Shi et al~1 has reported 9 uterine adenosarcomas among 116 uterine sarcomas during 11 years in West China Second Hospital.It consists of benign or atypical neoplastic glands within a sarcomatous stroma and represents only 8% of uterine sarcomas.…… Biography：XIANG Yang,Correspondenceto to:Dr.Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China(Fax:86-10-65124875.Email:xiangyang65@gmail.com

Intestinal lymphangiectasia (IL) is a rare disorder characterized by protein-losing enteropathy and fat malabsorption. The underlying cause of this disorder has been revealed to be impaired intestinal lymphatic drainage. According to the etiologies, IL can be classified into primary (idiopathic) form and secondary form.Diagnosis of primary IL is usually established by characteristic endoscopic findings and biopsy of intestinal mucosa。

Renal angiomyolipoma (AML) is hamartomas composed of blood vessels, smooth muscle and fatty tissue. In most cases, it is a tumor with benign behavior that may appear sporadically or be associated with tuberous sclerosis complex (TSC).~((1,2)) Rare cases of clinically aggressive or malignant AML have been reported.~((3-8))

Behcet disease (BD) is a chronic multisystem disease that presents with recurrent oral and genital ulceration and recurrent uveitis. Vascular and cardiac thromboses are rare but life threatening complications.We report a case of right internal jugular vein and brachiocephalic vein thrombus and successive cardiac thrombosis, which was finally diagnosed with BD。