Ureteral- artificial iliac artery fistula: A case report.

BACKGROUND: Ureteral-iliac artery fistula is a rare disease resulting from the pathological connection between the ureter and iliac artery, with artificial iliac artery-ureteral fistula being rarer. Iliac artery ureteral fistula is challenging to diagnose, and the misdiagnosis and mortality rates are high. CASE SUMMARY: A case of artificial iliac artery ureteral fistula was reported in this paper. The patient was a 69-year-old male with paroxysmal painless hematuria. The artificial iliac artery ureteral fistula was diagnosed by angiography. The hematuria was stopped after intravascular embolization, and no bleeding occurred after 6 months of follow-up. CONCLUSION: Ureteral arterial fistula should be considered when inconspicuous hematuria with previous iliac vessels is encountered in addition to local ureteral surgery history. A rapid endovascular approach is recommended for fistula identification.

[Effect of transcutaneous electric acupoints stimulation on vascular endothelial function and inflammatory factors after percutaneous coronary intervention].

OBJECTIVE: To observe the effect of transcutaneous electric acupoints stimulation (TEAS) on vascular endothelial function and inflammatory factors after percutaneous coronary intervention (PCI) in patients. METHODS: A total of 94 patients with coronary heart disease and undergoing PCI were randomized into a TEAS group and a sham-TEAS group, 47 cases in each one. In the TEAS group, TEAS started at unilateral Neiguan (PC6) and Ximen (PC4) 30 min before PCI till the end of PCI. In the sham-TEAS group, the procedure and persistent time were same as the TEAS group, but no electric stimulation was performed. Before treatment and at 8 h and 24 h after PCI, the levels of serum endothelin-1 (ET-1), von Willebrand factor (vWF), nitric oxide (NO), blood flow dependent diastolic function (FMD), interleukin-6 (IL-6), inteleukin-10 (IL-10), matrix metalloproteinase-9 (MMP-9) and high-sensitivity C-reactive protein (hs-CRP) were detected in the patients successively. RESULTS: Compared with the levels before PCI, the levels of ET-1 and vWF were all increased at 8 h and 24 h after PCI in the two groups (P<0.05) and the levels in the TEAS group were remarkably lower than those in the sham-TEAS group (P<0.05). Compared with the levels before PCI, the levels of NO and FMD at 8 h and 24 h after PCI were all reduced in the two groups (P<0.05) and the levels in the TEAS group were higher obviously than those in the sham-TEAS group (P<0.05). Compared with the levels before PCI, the levels of hs-CRP, MMP-9, IL-6 and IL-10 were all increased at 8 h and 24 h after PCI in the two groups (P<0.05); Compared with the sham-TEAS group, the levels of hs-CRP, MMP-9 and IL-6 were reduced and the level of IL-10 was increased at 8 h and 24 h after PCI in the TEAS group (P<0.05). CONCLUSION: TEAS effectively improves the vascular endothelial function and reduces serum inflammatory factors after PCI.

Disappeared intralenticular foreign body: A case report.

BACKGROUND: Intralenticular foreign body is rarely encountered in ophthalmic practice. In most cases, subsequent traumatic cataract requires cataract surgery for visual rehabilitation. CASE SUMMARY: A 35-year-old man was injured by iron filings in his left eye. After the injury, the patient tried to draw the object out by himself using a magnet; however, the foreign body (FB) was pushed to the equator of the lens. The FB was removed by a magnet through the anterior chamber accessed through the original capsular wound. Since most of the lens was transparent and only partially opaque after the operation, the lens was kept under close observation. After the surgery, the patient's visual acuity reached 20/20 from 2/20, visual function recovered very well, and local opacity of the lens remained stable. CONCLUSION: For intralenticular FB in the anterior cortex under the capsule, magnet may be a more advantageous way to remove the object.

Prevalence and correlates of mitral annular calcification in adults with chronic kidney disease: Results from CRIC study.

BACKGROUND: Risk factors for mitral annular calcification (MAC) and cardiovascular disease (CVD) demonstrate significant overlap in the general population. The aim of this paper is to determine whether there are independent relationships between MAC and demographics, traditional and novel CVD risk factors using cardiac CT in the Chronic Renal Insufficiency Cohort (CRIC) in a cross-sectional study. METHODS: A sample of 2070 subjects underwent coronary calcium scanning during the CRIC study. Data were obtained for each participant at time of scan. SUBJECTS: were dichotomized into the presence and absence of MAC. Differences in baseline demographic and transitional risk factor data were evaluated across groups. Covariates used in multivariable adjustment were age, gender, BMI, HDL, LDL, lipid lowering medications, smoking status, family history of heart attack, hypertension, diabetes mellitus, phosphate, PTH, albuminuria, and calcium. RESULTS: Our study consisted of 2070 subjects, of which 331 had MAC (prevalence of 16.0%). The mean MAC score was 511.98 (SD 1368.76). Age and white race remained independently associated with presence of MAC. Decreased GFR was also a risk factor. African American and Hispanic race, as well as former smoking status were protective against MAC. In multivariable adjusted analyses, the remaining covariates were not significantly associated with MAC. Among renal covariates, elevated phosphate was significant. CONCLUSION: In the CRIC population, presence of MAC was independently associated with age, Caucasian race, decreased GFR, and elevated phosphate. These results are suggested by mechanisms of dysregulation of inflammation, hormones, and electrolytes in subjects with renal disease.

Analysis of central mechanism of cognitive training on cognitive impairment after stroke: Resting-state functional magnetic resonance imaging study.

OBJECTIVE: To investigate the central mechanism of cognitive training in patients with stroke, using resting state (RS) functional magnetic resonance imaging (fMRI). METHODS: Patients with stroke and executive function and memory deficit were randomized to receive computer-assisted cognitive training (treatment group; total 60 h training over 10 weeks) or no training (control group). All participants received neuropsychological assessment and RS fMRI at baseline and 10 weeks. RESULTS: Patients in the treatment group (n = 16) showed increased functional connectivity (FC) of the hippocampus with the frontal lobe (right inferior, right middle, left middle, left inferior and left superior frontal gyrus) and left parietal lobe at 10 weeks compared with baseline. Patients in the control group (n = 18) showed decreased FC of the left hippocampus-right occipital gyrus, and right hippocampus-right posterior lobe of cerebellum and left superior temporal gyrus. Significant correlations were found between improved neuropsychological scores and increased FC of the hippocampus with the frontal lobe and left parietal lobe in the treatment group only. CONCLUSIONS: Increased RS FC of the hippocampus with the frontal and parietal lobes may be an important mechanism of cognitive recovery after stroke.

[Decomposition of life expectancy among permanent residents of Beijing, 2000 - 2010].

OBJECTIVE: To analyze the change of life expectancy and the impact of mortality by age and causes of death on this issue among permanent residents of Beijing. METHODS: Abridged Life Table and Arriaga method were used to calculate and to decompose the changes on life expectancy by age and causes of death in 2000 - 2010. RESULTS: From 2000 - 2010, life expectancy under this studied population had an increase of 3.35 years. Most part of the increases (44.27%, 1.48 years) within the last 10 years could be explained by the decrease of mortality in the population at age ≥ 80. Both cerebrovascular and heart diseases were contributing the most to the increment of life expectancy while mortality of malignant tumors appeared a negative contributor to this increment. CONCLUSION: From 2000 to 2010, increment in life expectancy contributed to the decrease of mortality in the elderly and the decrease of mortalities on both cardio- and cerebro-vascular diseases. The decrease of life expectancy was mainly due to the increase of mortality related to malignant tumors.

Assessing heat-related mortality risks in Beijing, China.

OBJECTIVE: To obtain the exposure-response relationship for temperature and mortality, and assess the risk of heat-related premature death. METHODS: A statistical model was developed using a Poisson generalized linear regression model with Beijing mortality and temperature data from October 1st, 2006 to September 30th, 2008. We calculated the exposure-response relationship for temperature and mortality in the central city, and inner suburban and outer suburban regions. Based on this relationship, a health risk model was used to assess the risk of heat-related premature death in the summer (June to August) of 2009. RESULTS: The population in the outer suburbs had the highest temperature-related mortality risk. People in the central city had a mid-range risk, while people in the inner suburbs had the lowest risk. Risk assessment predicted that the number of heat-related premature deaths in the summer of 2009 was 1581. The city areas of Chaoyang and Haidian districts had the highest number of premature deaths. The number of premature deaths in the southern areas of Beijing (Fangshan, Fengtai, Daxing, and Tongzhou districts) was in the mid-range. CONCLUSION: Ambient temperature significantly affects human mortality in Beijing. People in the city and outer suburban area have a higher temperature-related mortality risk than people in the inner suburban area. This may be explained by a temperature-related vulnerability.

[Characteristics of out-of-hospital acute coronary heart disease deaths of Beijing permanent residents at the age of 25 or more from 2007 to 2009].

OBJECTIVE: To analyze the characteristics of out-of-hospital acute coronary heart disease (CHD) deaths in Beijing permanent residents at the age of 25 or more from 2007 to 2009. METHODS: We analyzed the gender, age, geographical distribution, occupation, marital status and the extent of different education characteristics of out-of-hospital acute CHD deaths of the Beijing permanent residents at the age of 25 or more from 2007 to 2009 using the mortality information database from the Beijing Vital Registration Monitoring System. RESULTS: Of the total 41 732 acute CHD deaths, 30 159 (72.27%) died out of hospital and out-of-hospital mortality was 2.61 times higher than in-hospital mortality. Majority out-of-hospital death occurred in males (72.30%, 16 068/22 224), in 25 - 34 years old people (91.75%, 89/97), in residents living in remoter suburbs and counties (82.43%, 13 513/16 393), in rural population (89.50%, 10 017/11 192), in non-marital single (80.76%, 592/733) and in people less than five-years of schooling (83.95%, 11 388/13 565). Most out-of-hospital acute CHD death occurred at home (78.80%, 23 765/30 159). CONCLUSIONS: Out-of hospital acute CHD mortality is high in Beijing permanent residents at the age of 25 and over from 2007 to 2009. Male, 25 - 34 years old, living in outer suburbs and counties, rural population, non-marital single, and less education years are major risk factors for out-of-hospital acute CHD death.

Trabecular bone mineral density measurement using thoracic and lumbar quantitative computed tomography.

PURPOSE: To evaluate the agreement of bone mineral density (BMD) between lumbar (L) and individual thoracic (T) vertebrae and identify a standard thoracic spine level for BMD assessment in cardiac computed tomography (CT) images. MATERIALS AND METHODS: Three hundred subjects who underwent simultaneous chest and abdomen CT scans for clinical indications were included. A calibration phantom that extended from the first thoracic spine (T(1)) to the fifth lumbar (L(5)) was employed. Vertebral BMD were measured by QCT 5000 and NVivo systems. The association between three consecutive lumbar (L1-L3) and thoracic BMD (3T, initiation site equivalent to left main coronary caudally) was evaluated. RESULTS: There was a gradual decrease in BMD values from T(1) to L(3,) subsequently increasing in L(4) and L(5) in both genders. When stratified by gender, 3T BMD was significantly higher versus L(1-3) BMD (156.9 versus 141.9vmg/cm(3), P < .001) for women as well as for men (164.8 versus 151.0 mg/cm(3), P < .001). There is good correlation between 3T and L(1-3) BMD, the Pearson's correlation coefficients are 0.91 and 0.93 for women and men, respectively. We further analyzed the associations between L(1-3) and any individual spine of T(1)-L(5) and similar relationships were observed (r value, 0.62-0.98). The intraobserver, interobserver, and interscan variation measurement of thoracic quantitative CT was 2.5 (1.0, 95% CI 0.099-1.004); 2.6 (1.0, 95CI% 0.992-1.007), and 2.8% (1.0,95% 0.0994-1.008), respectively. CONCLUSION: The 3T BMD was highly correlated with L(1-3) BMD. Thoracic BMD can be measured during cardiac and lung CT imaging without need for additional participant burden or radiation dose. This highly reproducible methodology is actively being applied to large cohort studies to evaluate the prevalence of osteoporosis and track BMD over time.

Normal thoracic aorta diameter on cardiac computed tomography in healthy asymptomatic adults: impact of age and gender.

RATIONALE AND OBJECTIVES: To establish the normal criterion of ascending aortic diameter (AAOD) measured by 64 multidetector computed tomography (MDCT) and electron beam computed tomography (EBT) based on gender and age. MATERIALS AND METHODS: A total of 1442 consecutive subjects who were referred for evaluation of possible coronary artery disease underwent coronary computed tomographic (CT) angiography (CTA) and coronary artery calcium scanning (CACS) (55 + 11 years, 65% male) without known coronary heart disease, hypertension, chronic pulmonary and renal disease, diabetes, and severe aortic calcification. The AAOD aortic diameter, descending aortic diameter (DAOD), pulmonary artery (PAD), and chest anteroposterior diameter (CAPD), posterior border of the sternal bone to the anterior border of the spine, were measured at the slice level of mid-right pulmonary artery using end systolic trigger imaging. The volume of four chambers, ejection fraction of left ventricle, and cardiac output were measured in 56% of the patients. Patients' demographic information, age, gender, weight, height, and body surface area were recorded. The mean value and age-specific and gender-adjusted upper normal limits (mean +/- 2 standard deviation) were calculated. The linear correlation analysis was done between AAOD and all parameters. The reproducibility, wall thickness, and difference between end-systole and end-diastole were calculated. RESULTS: AAOD has significant linear association with age, gender, DAOD, and pulmonary artery diameter (P < .05). There is no significant correlation between AAOD and body surface area, four-chamber volume, left ventricular ejection fraction, cardiac output, and CAPD. The mean intraluminal AAOD was 31.1 +/- 3.9 and 33.6 +/- 4.1 mm in females and males, respectively. The upper normal limits (mean +/- 2 standard deviations) of intraluminal AAOD, were 35.6, 38.3, and 40 mm for females and 37.8, 40.5, and 42.6 mm for males in age groups 20-40, 41-60, and older than 60 years, respectively. Intraluminal aortic diameters should parallel echocardiography and invasive angiography. Traditional cross-sectional imaging (with CT and magnetic resonance imaging) includes the vessel wall. The mean total AAOD was 33.5 and 36.0 mm in females and males, respectively. The upper normal limits (mean +/- 2 standard deviations) of intraluminal AAOD were 38.0, 40.7 and 42.4 mm for females and 40.2, 42.9, and 45.0 mm for males in age group 20 to 40, 41 to 60, and older than 60 years, respectively. The inter- and intraobserver, scanner, and repeated measurement variabilities were low (r value >0.91, P < .001, coefficient variation <3.2%). AAOD was 1.7 mm smaller in end-diastole than end-systole (P < .001). CONCLUSIONS: The AAOD increases with age and male gender. Gender-specific and age-adjusted normal values for aortic diameters are necessary to differentiate pathologic atherosclerotic changes in the ascending aorta. Use of intraluminal or total aortic diameter values depends on the comparison study employed.

Hypovitaminosis D in chronic kidney disease.

BACKGROUND AND OBJECTIVES: Recent studies show high prevalence of suboptimal 25-hydroxyvitamin D levels in chronic kidney disease patients. This study sought to test the hypothesis that the prevalence of 25-hydroxyvitamin D deficiency is significantly higher in chronic kidney disease patients and, in diabetic nephropathy, low serum 25-hydroxyvitamin D is associated with abnormal serum parathyroid hormone, bone mineral density, and coronary artery calcification. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Study A used data from the Third National Health and Nutrition Examination Survey. Study B was a post hoc analysis of an observational study of coronary artery calcification in non-dialysis-dependent diabetic nephropathy. RESULTS: In study A, the adjusted odds for 25-hydroxyvitamin D deficiency were 32% higher in chronic kidney disease patients. This higher prevalence of 25-hydroxyvitamin D deficiency, however, could not be explained by differences in total vitamin D intakes. The consequences of suboptimal 25-hydroxyvitamin D levels were analyzed in 146 patients with diabetic nephropathy. The significant, inverse relationship between serum 25-hydroxyvitamin D and parathyroid hormone levels was attenuated to a nonsignificant level on multivariate adjustment. There was a significant, inverse relationship between bone mineral density and coronary artery calcification scores; neither was independently associated with serum 25-hydroxyvitamin D. The serum 25-hydroxyvitamin D levels declined modestly in 72 patients studied after 12.4 +/- 0.4 mo. CONCLUSIONS: 25-Hydroxyvitamin D deficiency is more common in chronic kidney disease, but this higher prevalence is unlikely to be a result of lower vitamin D intakes. The consequences of suboptimal 25-hydroxyvitamin D levels remain to be definitively elucidated.