BACKGROUND: The levels of superoxide dismutase (SOD) and nitric oxide (NO) in serum reflect the efficacy of drugs on anti-ischemic damage.Fumai yin improves significantly the prognosis of visual function in ischemic hemorrhagic fundus disease.OBJECTIVE: To observe the effects of f umaiyin on ultrastructure of ischemic retina and serum SOD and NO activity in experimental rats.DESIGN: Randomized controlled observation on single sample was designed.SETTING: Department of Ophthalmology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine,MATERIALS: The experiment was performed in Experiment Room of affiliated hospital of Shandong University of Chinese Medicine and Ultrastructure Room of Shandong University from November 2002 to July 2003.60 male Wistar rats were employed and randomized into fumaiyin group,fuming pian control group (fuming pian group) and the control group with physiological saline (PS group), 20 rats in each. Fumai yin is the concentrated decoction 2g/ml, composed of gouqizi (Fructus Lycii), huangjing (Rhizoma Polygonati), danshen (Radix Salviae Miltiorrhizae), wuweizi(Fructus Schisandrae), huangqi (Radix Astragali seu Hedysari), etc.METHODS: The model of retina ischemia was prepared by increasing in traocular pressure in 3 groups of rats. 0.5% pentobarbital 10 mL/kg was injected abdominally to anesthetize ocular surface. No.7 needle of tube with PS transfusion was inserted directly to bilateral anterior chambers of rats, and the infusion bottle was 145 cm above both eyes of rats, by which, 14kPa intraocular pressure was formed. It was observed that bulbar conjunctiva was pale, fundus blood flow was broken off and retina was is chemic. 1.5 hours later, the needle was withdrawn and perfusion was restored. In fumai yin group and fuming pian group, the drug was adminis trated 10 mL/kg (medicine concentration was 2 g/mL) and in PS group, PS of equal amount was applied. Gastric perfusion was done with different materials successively after modeling for 3 weeks. Colorimetry was used for assay of SOD activity and nitrate reductase method was used for assay of NO activity.MAIN OUTCOME MEASURES: ① Comparison of serum SOD and NO activities in each group. ② Alternation of ultrastructure of ischemic retina in 3 weeks of modeling observed with transmission electron microscope (TEM) in each group.RESULTS: Totally 60 rats were employed in the experiment. During breeding, in PS group, 2 rats were died of gastric perfusion and1 rat was died of biting, the rest 57 rats all entered result analysis. ① Comparison of serum SOD and NO activities in each group: Compared with fuming pian group, in fumai yin group, SOD activity was not changed remarkably (t=-1.165, P ＞ 0.05), but, NO activity was reduced significantly [(41.06±13.54), (27.39±7.45)μmol/L,t=3.958,P ＜ 0.01]. Compared with PS group, infumaiyin group, SOD activity was increased remarkably (t=4.628,P ＜ 0.01) and NO activity was reduced significantly (t=-3.767, P ＜ 0.01). ② Alternation of ultrastructure of ischemic retina in 3 weeks of modeling in each group: In fumaiyin group, retina was distinct in layer, newlyborne membrane discs were orderly in arrangement, membrane structure was normal, the numbers of retinal ganglion cells (RGCs) and organelle structure was basically normal and there was no obvious vacuole in neu rofibrous layer. In fuming pian group, retina was distinct in layer, newly borne membrane discs were slightly disturbed in arrangement, the numbers of RGCs and each organelle structure were mostly normal and there was no obvious vacuole in neurofibrous layer. In PS group, retina was not so distinct in layers, newly-borne membrane discs were disturbed in arrangement, the structure was abnormal, the numbers of RGCs was less,organalle structure was not integrative and large vacuole presented remarkably in neurofibrous layer.CONCLUSION: In fumaiyin group, SOD in serum was increased significantly and NO was reduced remarkably, explaining that fumaiyin provides good protection on injury of ischemic retina, which is probably related to that fumaiyin affects SOD and NO levels in serum and alleviates the damage of retinal ultrastructure induced by ischemia.

20?mm?Hg, nonpulmonary hypertension group (control group n=9), with preoperative mean pulmonary artery pressure

BACKGROUND:Conventional dynamic hip screw or artificial joint replacement can be used to treat unstable intertrochanteric fracture in aged patients. It remains unclear whether we should select one-stage replacement or remedial joint replacement after failture, and there is no unified standard globaly. OBJECTIVE: To observe the outcomes and prognosis of one-stage artificial joint replacement for unstable intertrochanteric fracture in aged patients. METHODS:From April 2008 to October 2011, 21 patients with unstable intertrochanteric fracture in aged patients were repaired with one-stage artificial joint replacement at the Second Department of Orthopedics, Changji Prefecture People’s Hospital. Among 21 patients, 1 patient previously combined with avascular necrosis of the femoral head and traumatic arthritis received biological artificial total hip replacement. Three cases were subjected to standard bone cement bipolar artificial femoral head replacement. 17 cases underwent biological bipolar artificial femoral head prosthesis replacement. Al artificial joint, internal fixation material and accessory joint replacement surgical instruments were purchased outside China. Al patients were folowed up regularly. Hip joint function was assessed by Harris hip score. RESULTS AND CONCLUSION: Al operations were completed by the same group of physicians. Operation time was 30-60 minutes, averagely 42 minutes. Incision length was 8 to 15 cm, averagely 11 cm. Average intraoperative blood loss was 50-300 mL, averagely 150 mL. The number of transfusion cases was 13. 1.5 U blood was transfused averagely in each patient during hospital stay. One 76-year-old patient combined with hypertension, coronary heart disease and diabetes suffered from sudden death due to acute myocardial infarction at 9 days after replacement. B ultrasound revealed venous thrombosis of calf muscle of double lower extremities at 3 days after replacement. No complications such as prosthetic loosening, sinking, infections and thrombosis were detected. Except 1 case died, the other 20 cases received folow-up for 6-49 months. Harris hip score was 73±4 before discharge and 82±6 during last folow-up. These data confirm that effects of one-stage artificial joint replacement for unstable intertrochanteric fracture in aged patients are affirmative, but the number of case is stil less, and deserves further investigations. We suggest that in patients with conformed indication, one-stage artificial joint replacement can be the first choice.

BACKGROUND:Autologous peroneus brevis and alogeneic tendon are often used for reconstruction of lateral colateral ligament of the ankle joint, but these two kinds of materials have different histological and biomechanical properties. OBJECTIVE:To compare the clinical effects of autologous peroneus brevis and alogeneic tendon to reconstruct lateral colateral ligament of the ankle joint. METHODS: Sixty-six patients with chronic external ankle instability caused by old injury to lateral colateral ligament of the ankle joint were enroled, aged 15-63 years. The 34 of 66 patients underwent lateral ligament reconstruction using autologous peroneus brevis and the rest 32 patients received lateral ligament reconstruction using alogeneic tendon. After reconstruction, reaction time of the peroneous brevis, talar tilt angle and anterior talar translation, visual analog scale score and the American Orthopaedic Foot and Ankle Society (AOFAS) score were compared between the two groups. RESULTS AND CONCLUSION:At the last folow-up, the visual analog scale score, tilt angle and anterior talar translation were lowered in the two groups compared with the previous (P < 0.05), and the AOFAS scores were increased significantly in the two groups (P < 0.05); the reaction time of the peroneous brevis was increased inthe autologous peroneus brevis group (P < 0.05) and decreased in the alogeneic tendon group (P < 0.05); the above-mentioned indexes had no difference between the two groups. These findings indicate that autologous peroneus brevis and alogeneic tendon have similar effects on the lateral ligament reconstruction in terms of postoperative ankle function, stability and activity levels, but the alogeneic tendon shows advantages on less trauma and shorter operation time.

BACKGROUND:A series of inflammatory signal pathways are activated accompanied by increasing expressions of inflammatory factors after periodontal tissues being stimulated by exogenous substances like bacterium. Inflammation is closely related to periodontal tissue repair and regeneration.
OBJECTIVE:To il ustrate the correlation of immune response of periodontitis and periodontitis-related inflammatory cytokines to p38 mitogen activated protein kinase (p38MAPK) pathway, and to provide a new idea and method for the treatment of periodontitis in the future.
METHODS:The related literatures of periodontitis and p38MAPK pathway published from January 1990 to January 2016 were retrieved from the databases of CBM, CNKI, SWIC and PubMed. The research and progress of periodontal tissue repair and regeneration after periodontitis were analyzed.
RESULTS AND CONCLUSION:Total y 36 literatures were enrol ed final y. Inflammation-regulated and inflammation-associated signaling pathways as wel as subsequent expression of inflammatory mediators can partly control the excessive disease-induced inflammation and immune responses of the host, among which p38MAPK signaling pathway may be involved in the occurrence and development of periodontitis. More studies, however, are needed to validate these findings. The regulation of p38MAPK signaling pathway is stil of great significance in the treatment of periodontal disease, and we hope to provide a new insight and basis for clinical diagnosis and treatment of periodontitis.

Objective:To explore the value of dual-input perfusion imaging (DI-CTP) in differential diagnosis of single inflammatory pseudotumor and peripheral lung cancer with 320-slice CT. Methods: Totally 52 patients with single pathological proved peripheral lung cancer (28 with adenocarcinoma, 24 with squamous cell carcinoma) and 21 patients with inflammatory pseudoaneurysm were enrolled. Pulmonary artery flow (PF) and bronchial artery flow (BF) were obtained, the perfusion index (PI) and total perfusion (TLP) were calculated. Time-density curve was obtained from DI-CTP, and the enhanced time to peak (TTP) were calculated. The above indexes were analyzed among squamous cell carcinoma, adenocarcinoma and inflammatory pseudotumor, and their values in differential diagnosis of peripheral lung cancer and inflammatory pseudotumor were evaluated. Results: There were significant differences of PF and TTP among squamous cell carcinoma, adenocarcinoma and inflammatory pseudotumor (all P<0.01), also of PF, TLP and TTP between inflammatory pseudotumors and peripheral lung cancer (all P<0.01). AUC of TTP was 0.99 (P<0.01), which had high diagnostic value. Taken TTP=16.3 s as the critical value, the sensitivity and specificity in predicting inflammatory pseudotumors and peripheral lung cancer was 100% and 95.0%, respectively. AUC of PF and TLP was 0.76 (P<0.01) and 0.71 (P<0.01), respectively, which had moderate diagnostic value. Conclusion: Inflammatory pseudotumor and peripheral lung cancer both have pulmonary artery and bronchial artery blood supply. TTP is helpful to differential diagnosis of inflammatory pseudotumor and peripheral lung cancer.

Objective This study is to evaluate the advantages between percutaneous and peratrial device closure of secundum atrial septal defects(ASD) under single transesophageal echocardiographic (TEE) guidance.Methods From December 2010 to December 2012,53 patients with the ASD of≤25 mm in diameter underwent percutaneous device closure under simple TEE guidance(the percutaneous group).The device was implanted through the femoral vascular access.Fifty patients with similar age and similar-sized ASD to the percutaneous group,were selected from 350 consecutive patients who underwent peratrial device closure of ASD and assigned to the peratrial group.The ASDs were occluded through a right minithoracotomy approach.The success rate,intracardiac manipulation time,procedural time,postoperative stay and the follow-up results were recorded.Results When the maximum diameter of ASD was ＜ 20 mm,the success rate of both groups was 100％.When the ASD diameter was 20 mm but 25 mm,the success rate was 84％ in the percutaneous group and 100％ in the peratrial group.Three patients failed in the percutaneous group with the ASD diameter of 20 mm and the aortic rim of 3 mm.They were successfully converted to peratrial device closure.The average intrcardiac manipulation time was(20±7) minutes in the percutaneous group and (5 ± 6) minutes in the peratrial group(P ＜ 0.05).The average procedure time was(24 ± 7) minutes in the percutaneous group and (39 ± 6) minutes in the peratrial group(P ＜ 0.05).The postoperative hospital stay was (3.0 ± 0.8) days in the percutaneous group and(4.7 ± 1.5) days in the peratrial group(P ＜ 0.05).Conclusion The percutaneous device closure of ASD under simple TEE guidance is feasible,safe,and efficacious in patients with the ASD diameter of ≤25 mm.It has the advantages of less trauma,less procedural time,shorter hospital stay and better cosmetic results.However,when the ASD diameter was 20 mm and the aortic rim was 3 mm,the peratrial approach may be a better choice.

Objective The aim of this study was to evaluate the feasibility,safety and efficacy of peratrial device closure of ventricular septal defect (VSD) through a right parasternal approach.Methods Between May 2011 and July 2012,47 patients (peratrial group),aged 7 months to 37 years,underwent peratrial device closure of VSD through a right parasternal approach.According to the same inclusion criteria,47 patients who underwent perventricular device closure of VSD were randomly chosen as the control group (perventricular group).In the peratrial group,a 1.5 to 2.0 cm parasternal incision was made in the right fourth or third intercostal space.The pericardium was incised and cradled.Two parallel pursestring sutures were placed at the right atrium near the atrioventricular groove.After puncture,a specially designed hollow probe was inserted into the right atrium.The probe was passed through the tricuspid valve into the right ventricle.Under transesophageal echocardiographic guidance,the tip of the probe was adjusted to point to or cross the defect.A flexible guidewire was rapidly inserted into the left ventricle through the channel of the probe to establish a delivery pathway,and the delivery sheath was introduced through the defect over the wire.Then the device was deployed to close the defect.Results Successful implantation of the device was achieved in both groups of patients (100％).In the peratrial group,the entrance and the exit diameter of the VSD were (7.4 ±4.1) mm (range,2.0 to 20.0 mm) and (3.4 ± 1.2)mm (range,2.0 to 7.0 mm),respectively.The mean device size was (6.3 ± 1.5)mm (range,4.0 to 12.0 mm).The mean intracardiac manipulation time is longer in the peratrial group [(15 ± 13) min] than in the perventricular group[(8 ± 5)min],P ＜ 0.01.But the procedure time is shorter in the peratrial group[(56 ± 24) min] than in the perventricular group [(72 ± 16) min],P ＜ 0.01.During the follow-up period of 1 to 12 months,no device-related complications were found.Conclusion The peratrial device closure of VSD is feasible,safe,and efficacious.It has the advantages of less invasiveness,better cosmetic results,and a shorter procedure time.

Objective To explore the clinical selection of surgical methods for pure stenosis at the end of the common bile duct.Methods The clinical data of 43 cases of pure stenosis at the end of the common bile duct treated in this hospital from October 2003 to June 2009 were retrospectively analyzed.Of the 43 cases, 12 underwent endoscopic sphincterotomy(EST), 9 sphincteroplasty of Oddi, 5 pancreaticoduodenectomy,8 Roux-en-y choledochojejunostomy and 5 choledocoduodenostomy,4 underwent drainage of the T tube after exploration of the biliary passage.Results Among 37 patients did not undergo the radical pancreaticoduodenectomy,6 had space-occupying lesions 5-19 months postoperatively.Five of them received pancreaticoduodenectomy again.Conclusion Pure stenosis at the end of the common bile duct should be carefully managed.

Objective To investigate the incidence of gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) in Chengdu City in 2010 and summarize clinical characteristics of GEP-NEN.Methods The incidence of GEP-NEN was estimated with the data in 2010 from the databases of West China Hospital and Chengdu Health Information Centre.Results A total of 77 cases of GEP-NEN were diagnosed in West China Hospital in 2010.Ten cases from other hospitals or non-Chengdu citizenship were excluded,so a total of 67 cases were included in this study.In 2010,the incidence of GEP-NEN was 1.86/105 in Chengdu City.Among 67 GEP-NEN cases,most lesions were located in pancreas and rectum (38 cases,56.7％),followed by stomach (10 cases),esophagus (seven cases) and duodenum (four cases).Among 57 GEP-NEN cases which had pathotogial grading,26 cases (45.6 ％) had neuroendocrine carcinomas or mixed adenoneuroendocrine carcinomas when diagnosed.Conclusions In 2010,the incidence of GEP-NEN in Chengdu City is similar to the reports from other countries.Pancreas,rectum and upper gastrointestinal tract are predilection sites of GEP-NEN.The diagnosis rate of early GEP NEN needs to be raised.