Objective To analyze epidemiologie and injury characteristics of traffic injuries in Shenzhen through emergency department. Methods A questionnaire was pre-designed to collect data of patients admitted to six general emergency departments of six district in Shenzhen from January 2007 to December 2007 for clinical analysis. Results There were 1 328 patients with road traffic injuries, at age range of 2-84 years (average 31 years). According to occupation, most patients were local workers and migrant workers (57.8%). The accidental vehicles were mostly cars (48.5%). Most accidents (78.6%) occurred in urban streets. As for time distribution of traffic injuries, most injuries happened on Friday and Saturday (accounting for 17.8% and 18.7% respectively), especially on Friday (r = 0.166 0, P <0.01). There was central tendency around 15:35 p.m. in one day (r = 0.285 6, P < 0.01). The age of male was (32.36±8.70) years and that of female (29.96±4.32) years, with statis-tical differences (P < 0.05). Of patients followed up, 84.4% patients could work on their original jobs, 8.5% needed ehange of their jobs and 7.1% lost the ability of work. Conclusions It is neeessary to strengthen road safety education among local workers and migrant workers to improve their awareness of road safety. Traffic administrators and road safety marks should be added in the chief period and districts where road traffic injuries happen most frequently. Controlling the number of small cars may be effective to reduce traffic accidents.

Objective To investigate the clinical efficacy of re-modified Sugiura procedure for the treatment of portal hypertension.Methods The retrospective cohort study was adopted.The clinical data of 119 patients with portal hypertension who were admitted to Second People's Hospital of Yichang from June 2006 to October 2014 were collected.Seventy-two patients who underwent pericardial devascularization were allocated into the Hassab group,and the other 47 patients who underwent the re-modified Sugiura procedure were allocated into the R-M Sugiura group.All the patients firstly underwent splenectomy.The patients of the Hassab group received the classical surgery of pericardial devascularization,and the operation in the R-M Sugiura group was improved on the modified Sugiura procedure in several aspects:(1) the cardia was transected obliquely.(2) Paraesophageal vessels were preserved by selective pericardial devascularization.(3) The pedicled omentum covered the anterior anastomosis and was sutured to the posterior abdominal wall.Observed indices included (1) intraoperative and postoperative situations:operation time,volume of intraoperative blood loss,postoperative anal exhaust time and duration of postoperative hospital stay.(2) Postoperative complications:postoperative pleural effusion,perioperative digestive tract re-bleeding,difficult swallowing,portal vein thrombosis and gastric dynamic dysfunction.(3) Situation of follow-up.The follow-up was performed by telephone interview and outpatient examination to observe the grading of the esophageal varices at postoperative month 6 and 18 using gastroscope till February 2016.Measurement data with normal distribution were presented as x ± s,and comparison between groups was done by the t test.Count data were analyzed by the chi-square test.Ranked data were analyzed by Wilcoxon rank test.Results (1) Intraoperative and postoperative situations:operation time of the Hassab group and the R-M Sugiura group was (201 ± 27) minutes and (255 ± 32) minutes,respectively,with a statistically significant difference between the 2 groups (t =9.67,P ＜ 0.05).The volume of intraoperative blood loss,postoperative anal exhaust time and duration of postoperative hospital stay were (380 ± 86) mL,(2.7 ± 0.7) days,(14.2 ± 2.4) days in the Hassab group and (401 ± 72) mL,(3.0 ± 1.7) days,(15.1 ± 2.7) days in the R-M Sugiura group,respectively,showing no statistically significant difference (t =1.35,1.26,1.86,P ＞ 0.05).(2) Postoperative complications:dysphagia was detected in 3 patients of the Hassab group and in 10 patients of the R-M Sugiura group at the postoperative day 10,with a statistically significant difference between the 2 groups (x2 =0.86,P ＜ 0.05).However,dysphagia was detected in 1 patient of the Hassab group and in 4 patients of the R-M Sugiura group at the postoperative day 20,showing no statistically significant difference between the 2 groups (x2 =2.03,P ＞ 0.05).The number of postoperative pleural effusion,perioperative digestive tract rebleeding,portal vein thrombosis and gastric dynamic dysfunction of the Hassab group and the R-M Sugiura group were 23,6,10,8 cases and 20,1,6,6 cases,respectively,showing no statistically significant difference (x2=1.39,1.02,0.03,0.08,P ＞ 0.05).(3) Situation of follow-up:all the patients were reexamined using gastroscope to observe the grading of esophageal varices.There were 0,7,56,9 patients of G0,G Ⅰ,G Ⅱ,G Ⅲ grading of varices in the Hassab group and 35,12,0,0 patients in the R-M Sugiura group at postoperative month 6,showing a statistically significant difference between the 2 groups (Z =-9.64,P ＜ 0.05).There were 0,0,48,24 patients of G0,G Ⅰ,G Ⅱ,G Ⅲ grading of varices in the Hassab group and 24,20,3,0 patients in the R-M Sugiura group at postoperative month 18,showing a statistically significant difference between the 2 groups (Z =-9.28,P ＜ 0.05).Conclusion The re-modified Sugiura procedure is more effective than the Hassab operation in curing portal hypertension,and it could also reduce the rate of rehemorrhage and improve the short-term and long-term prognosis.

Objective: To translate Millon Clinical Multiaxial Inventory Ⅲ (MCMI-Ⅲ) into Chinese, and then test its reliability and validity. Methods: MCMI-Ⅲ was administered to patients with mental disorders and normal people. Some subjects completed SAS, SDS, HAMA and HAMD simultaneously. 7-14 days later, some subjects completed the Chinese version of MCMI-Ⅲ again. Results: Cronbach’s alpha and the split-half reliability of MCMI-Ⅲ was 0.957 and 0.919, respectively. The mean Cronbach’s alpha, split -half and test -retest reliability of the subscales were 0.72, 0.70, 0.71 respectively. Most of the items correlated significantly (P

Objective To review the experience of surgical management of coronary artery disease associated with valvular heart disease. Methods From 1998 to 2004, fifty-seven patients with coronary artery lesion and valvular disease underwent coronary artery bypass grafting with concomitant valvular operation. The mean age of the patients was 60 years. Heart function (NYHA) was class II in 9 patients, class III in 37, class IV in 11. 37 patients had mitral valve lesion, 11 aortic valve lesion, and 9 with lesions of both valves. 26 cases had single-vessel disease, 20 with double-vessel disease,11 with triple-vessel disease, and 9 with main artery lesion. After cardiac arrest with the aid of cold cardioplegia under moderate cardiopulmonary bypass, distal anastomosis of the saphenous vein (SV) to the target vessels was first performed followed by valve replacement (49 patients) or valvular plasty (8 patients). The left mammary artery was grafted to the left anterior descending artery before aortic declamping. Proximal anastomosis of the SV to the aorta was finally finished on beating heart. The mean bypass time was 173.5 min and the mean duration of aortic cross-clamping was 112.6 min. Results Except one patient, no mortality and severe morbidity occurred during hospitalization. Heart function was improved to class I-II and no one died during follow-up period. Conclusion CABG combined with valve surgery can be safely performed with good results.

Objective To study the clinical characteristics and surgical treatment of left ventricular outflow tract obstruction (LVOTO) caused by congenital accessory mitral valve (AMV) tissue. Methods Two cases were treated in our department. Pre-operatively, case 1 was diagnosed as congenital heart disease with severe LVOTO and anterior mitral valve cleft; case 2 was diagnosed as congenital atrial septal defect combined with AMV and mild LVOTO as well as mild mitral valve regurgitation. Both patients were operated on under CPB. In case 1, LVOTO was caused by AMV which belonged to Type I (fixed type). In case 2, the AMV was type II (mobile type). Results Both AMV tissues were resected through atrial septum, and combined cardiac disorders were repaired simultaneously. The operations were successful and the patients were discharged with good results. Echocardiography revealed that the LVOTO almost disappeared. Conclusions LVOTO caused by AMV is a rare congenital heart disorder. AMV may be removed with acceptable postoperative outcome. Prophylactic removal of AMV tissue should not be attempted in patients with no or mild LVOTO and no other associated heart defects. These patients should be followed and observed periodically by Doppler echocardiography to identify any progression in LVOTO.

Objective To study the clinical manifestations of cardiac myxoma and the morbidity, mortality and recurrence rate following surgery in our institution. Methods From December 1989 to November 2004, 71 patients underwent complete excision of primary or recurrent intracardiac myxoma. Pre-operative diagnosis was established by echo-cardiography. All patients underwent operation soon after the diagnosis of myxoma was made. Combined cardiac disorder was also treated synchronously. The excised myxoma was histopathologically studied routinely. Results Myxoma most commonly occurred in the fourth decade of life. Its commonest location (92.9%) was the left atrium (LA), but 3 patients had myxoma in the right atrium (RA), one in the right ventricle (RV), and one in the left ventricle (LV). Patients with LA myxoma simulated mitral stenosis clinically, whereas patients with RA and RV myxoma presented features of right heart failure. Patients with LV myxoma had the symptoms of the left ventricular outlet tract obstruction. 6 patients had history of embolism. Combined cardiac diseases included coronary heart disease (2 cases), rheumatic mitral stenosis (2 cases), and severe mitral insufficiency (3 cases), and severe tricuspid insufficiency (4 cases). One patient had myxoma recurrence for three times after his first surgery, and died in the fourth operation. All the other patients survived the operation with the condition improved during the follow-up period. No late deaths were observed. Conclusions Echocardiography is the ideal diagnostic tool. Immediate surgical treatment is indicated in all patients. Cardiac myxoma can be excised with a low rate of mortality and morbidity. Close follow-up for detecting recurrence is necessary.

Objective To investigate the morphological and functional changes in the heart of patients with giant left ventricle after valve surgery,and to explore the relationship between the morphology of left ventricle and its function.Methods 86 patients with severely dilated left ventricle underwent echocardiographic examination before and 7-14 days after operation.Left ventricle diameters were measured(LVEDD,LVESD)and matched to the body surface area(LVEDDI,LVESDI).Left ventricular ejection fraction(EF)and fractional shortening(FS)were calculated.Results Left ventricular dimensions significantly decreased 7-14 days after operation.LVEDD was 76.48?5.21mm before operation and 62.58?12.62mm after operation(P

Objective To investigate the analgesic effect and the safety assessment of intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine for post-cesarean analgesia.Methods One hundred and eighty parturients (ASA Ⅰ-Ⅱ) undergoing elective cesarean section with combined spinal and epidural anesthesia were divided into morphine group (group A),sufentanil + morphine group(group B),flurbiprofen axetil+sufentanil+ morphine group(group C) with 60 cases in each group.All patients were used subarachnoid epidural anesthesia,at the end of the surgery,1.5 mg morphine diluted to 5 ml saline was injected into the epidural space of each patient.Additional,group B and group C received patient-controlled intravenous analgesia after cesarean section.Flurbiprofen axetil and sufentanil were diluted to 100 ml with saline.The visual analog scale (VAS) of rest and dynamic incisional pain and uterine contraction pain,Ramsay sedation scale (RSS),and adverse events were recorded at 6,12,24 h after operation.Results At 6,12,24 h after operation,the VAS scores of rest and dynamic incisional pain and uterine contraction pain in group B and group C were statistically lower than those in group A [rest incisional pain:(2.6 ± 0.6),(2.7 ± 0.4),(2.8 ± 0.3)scores in group A; (2.3 ± 0.3),(2.3 ± 0.4),(2.2 ± 0.3) scores in group B; (1.8 ± 0.4),(1.7 ±0.5),(1.9 ±0.4) scores in group C; dynamic incisional pain:(5.7 ±0.9),(5.5 ± 0.8),(5.6 ± 1.0) scores in group A; (3.8 ± 0.4),(3.7 ± 0.5),(3.7 ± 0.4) scores in group B ; (2.7 ± 0.4),(2.4 ± 0.5),(2.4 ± 0.6) scores in group C ; uterine contraction pain:(5.7 ± 1.2),(5.9 ± 0.9),(5.8 ± 1.1) scores in group A; (3.0 ± 0.5),(3.1 ± 0.6),(3.2 ± 0.7)scores in group B; (2.5 ± 0.5),(2.5 ± 0.6),(2.4 ± 0.4) scores in group C],and group C were lower than group B,and there were significant differences (P＜0.05).At 6,12,24 h after operation,Ramsay score in group B and group C was higher than that in group A [(1.8 ± 0.5),(1.7 ± 0.4),(1.9 ± 0.5) scores in group A; (3.4 ± 0.8),(3.2 ± 0.7),(3.3 ± 0.6) scores in group B; (2.7 ±0.7),(2.7 ±0.5),(2.6 ± 0.4)scores in group C],and group C was higher than group B,and there were significant differences (P ＜ 0.05).The incidence of adverse events in group A and group C was lower than group B [8.3％(5/60) and 23.3％(14/60) vs.40.0％(24/60)],and group A was lower than group C,and there were significant differences (P ＜ 0.05).Condusion Intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine could perform better analgesic on postoperative incisional and uterine contraction pain after cesarean section and the incidence of adverse events is less than sufentanil combined with morphine.

BACKGROUND:Previous studies have found that cyclic tensile stress can induce the proliferation of human periodontal ligament fibroblasts in a certain time. OBJECTIVE: To observe the effect of cyclic tensile stress on the expression of connective tissue growth factor in human periodontal ligament fibroblasts, and to clarify the role of JNK, p38MAPK, PI3K pathway in the cyclic tensile stress-induced expression of connective tissue growth factor in human periodontal ligament fibroblasts. METHODS:Human periodontal ligament fibroblasts culturedin vitro were given stimulation of cyclic tensile stress in vitro for 1, 6, 12, 24 hours using multi-channel cel stretch stress loading system (experimental group). Control group was set up and not given any stimulation at the same time. The cels under stress application for 12 hours were given specific inhibitors of JNK, p38MAPK, PI3K respectively at the beginning, and were compared with those with no inhibitors. The concentrations of connective tissue growth factor in the culture supernatant were measured by ELISA. The mRNA expression of connective tissue growth factor in human periodontal ligament fibroblasts was detected by real-time RT-PCR. RESULTS AND CONCLUSION:Compared with the control group, the expression of connective tissue growthfactor in human periodontal ligament fibroblasts under cyclic tensile stress began to increase at 1 hour, increased manifestly at 6 hours, reached the peak at 12 hours, and then decreased at 24 hours. The expression of connective tissue growth factor was reduced by the specific inhibitors of JNK, while the specific inhibitors of p38 MAPK, PI3K had not the same effect. In a certain time, the cyclic tensile stress can induce a time-dependent increase in mRNA and protein levels of connective tissue growth factor. Along with the extending of time, the expression of connective tissue growth factor begins to decrease. Cyclic tensile stress can regulate expression of connective tissue growth factor in human periodontal ligament fibroblasts via the JNK pathway.

Objective To summarize the experience in diagnosis and surgical treatment of double-chambered right ventricle (DCRV). Methods From 1990 to 2001, 95 patients with DCRV received surgical correction, including 56 males and 39 females, with an age ranging from 1 to 48. 82 cases had other cardiac abnormalities, 56 of whom had ventricular septal defect (VSD). Right atrium incision was made in 8 patients, right ventricular infundibular incision in 30, and both right atriotomy and ventriculotomy in 57. Results Muscular ring was found in 61 patients, and muscular shelf in 34. No death occurred. Preoperatively, 15 patients and 3 patients were misdiagnosed by echocardiography as VSD and pulmonary stenosis, respectively. The diagnosis was corrected during operation. Conclusions DCRV was often found to be complicated with other cardiac disorders. Echocardiography was the main diagnotic method, but the misdiagnosis was not uncommon. So it was very important to make surgical exploration, especially on tricuspid valve and pulmonary valve during intraventricular operations. Right ventricular infundibular incision was convenient and dependable.