Objective To explore the effect of Zhibitai capsule in the treatment of elderly coronary artery disease patients with normal lipid,and to investigate its influence on prognosis.Methods 90 elderly coronary artery disease patients with normal lipid were randomly divided into the control group (n =30),the treatment group 1 (n =30) and the treatment group 2 (n =30).The control group received routine treatment,once a day for 2 months.The treatment group 1 received the Xuezhikang capsule,once a day for 2 months.The treatment group 2 received the Zhibitai capsule,once a day for 2 months.The expression of inflammatory factors,the level of blood fat,the maintenance rate of sinus rhythm and the incidence rate of embolism before and after treatment were compared among the three groups.Results After treatment,the levels of hs-CRP,IL-6,TNF-α,TC,TG,LDL-C of the three groups were significantly lower than those before treatment(P ＜ 0.05),and the level of HDL-C was significantly higher than before treatment (P ＜ 0.05).The levels of hs-CRP,IL-6,TNF-α,TC,TG,LDL-C in the treatment group 2 were significantly lower and the level of HDL-C was significantly higher than the other two goups (P ＜ 0.05).Moreover,the differences between the control group and the treatment group 1 were not statistically significant.The maintenance rate of sinus rhythm of the treatment group 2 was significantly higher and the incidence rate of embolism was significantly lower than the treatment group 1.Conclusion For elderly coronary artery disease patients with normal lipid,the Zhibitai capsule has ideal effect in controlling inflammation,which can delay the progress of atherosclerosis,decrease the major cardiovascular events and better than the Xuezhikang capsule.

[Objective]To investigate the best internal fixation methods of upper segment complicated femoral fractures(USCFF).[Method]Fifty-two cases(54 limbs) with USCFF were treated.In all patients open fracture reduction with use of internal fixation were done.Intramedullary interlocking nails(IIN) were used to treat 32 cases(34 limbs) of adult's USCFF and 130? plate were used to treat 20 cases of children's USCFF.Thirty-six limbs of them were closed fractures,and 18 limbs were opene.Measures of auto-ilium transplant(5 limbs),homolegous allograft bone transplant(10 limbs)were also taken.[Result]Fifty-two patients were followed-up from 9 to 40 months with an average of 16 months.Infection,fracture nonunions,malunion and femoral head necrosis complications were not found.The average period of union of adult and children fractures was respectively 6.8 months and 6.5 months.The long term effect was evaluated according to Ma Yuanzhang's evaluation standard,94.4 percent showed excellent function of joints and limbs.[Conclusion]Appropriate selection of internal fixation according to the age of patients and satisfactory fracture reduction are key points to improve outcome of USCFF.IIN in treating fiacture of adult and 130? plate in treating fracture of children are more ideal selections.

Objective To evaluate the advantage of video-assisted mini thoracotomy for patients with esophageal cancer compared with routine open thomcotomy.Methods Perioperative clinical results were compared between 24 csses received VAMT(test group)and 26 cases underwent routine open thoracotomy(control group)during the same period.All the cancer stages were T2-3N0-1M0.Results This study showed that VAMT Was a minimally invasive swgew with shorter operation time(40.0±3.3)min vs.(70.3±3.2)min,P＜0.05)and had less bleeding volume both during and after operation compared to the control group(108.1±15.2)ml V8.(200.1±11.3)ml,(380.8±45.4)ml vs.(780.1±52.2)ml,P＜0.05).No significant differences were observed in the two groups with respect to complication occurrence rate(4.2%vs.19.2%,P＞0.05).Conclusion It is suggested that VAMT is safe,reliable and less invasive in the treatmem of esophagus carcinoma.

Objective A retrospective review of the use of delayed sterna closure (DSC) after pediatric cardiac operations.The purpose of this study is to access the morbidity of DSC and to analyze the risk factors that may predict the need for DSC.Methods Between January 2008 and December 2011,5 546 infants (2 843 males,2 703 females) underwent cardiac operations through midterm sternotomy in Shanghai Children' s Medical Center.Median age was 5 months(1 day to 11 months) and mean weight was 6.1 kg(2.0-12.5 kg).The pathologies included transposition of great artery(TGA),corctation of aorta (CoA),interruption of aortic arch (IAA),pulmonary atresia (PA),truncus arteriosus (Truncus),complete atrioventricular septal defect(CAVSD),total anormalous pulmonary vein connection (TAPVC),double outlet of right ventricle(DORV),tetralogy of Fallot(TOF),and ventricular septal defect(VSD),et al.All hospital records were reviewed and clinical data were studied and analyzed.Results A total of 313 patients had DSC (5.6％).There were 191 males and 122 females.The reasons for DSC are hemodynamic instability in 296,bleeding in 11,and ECMO(or VAD) in 6 patients.Two hundred and fiftyone (80.2％) patients were less than 5 kg,84 (26.8 ％) patients were neonates,and 125 (39.9％) patients aged between one and three months old.The incidences of DSC for these patients were 13.9％,34.4％,and 18.4％ respectively.The diagnosis of complex congenital heart defects had a high risk of DSC.The incidences of DSC for TGA,CoA,IAA,PA,Truncus,CAVSD,TAPVC,and DORV were 28.8％,17.8％,43.1％,9.0％,30.4％,6.5％,and 10.8％ respectively.The DSC patients had longer duration of CPB time(147 min versus 72 min) and clamping time(81 min versus 40 min).In 282 patients the sternums were closed 1-11 days after the initial operation.In 3 cases the trial of closure failed for the first time and succeeded a second time until several days later.Fouty-six patients died ultimately including 15 patients died after the closure of sternum with a total mortality of 14.7 ％.Surgical site infection occurred in 17 patients (5.4％),and surgical intervention were needed in 4 severe cases(1.3％).Conclusion Neonates,an age less than 3 months,weight less than 5 kg,long CPB time and clamping time,and the diagnosis of complex congenital heart defects were risk factors of the need for delayed sterna closure after pediatric cardiac operations.

Objective To investigate the effect of 23.4% hypertonic saline(HTS)on intracranial pressure(ICP), cerebral peffusion pressure(CPP), cerebral blood flow(CBF)in poor-grade patients with subarachnoid hemorrhage(SAH).Methods Sixteen patients(Glasgow coma score ≤ 8)with poor-grade SAH received 23.4% hypertonic saline intravenously for elevated ICP.ICP, mean arterial pressure(MAP), CPP and the middle cerebral artery flow velocity(FV)were observed and recorded before and at 30, 60, 90,120, 150, 180 min after the injection respectively.Results Thirty minutes postinfusion, a significant increase in MAP, CPP, FV was seen together with a decrease in ICP(P<0.05).ICP remained reduced for 180 minutes, CPP and FV remained elevated for 90 minutes(P < 0.05).Conclusions HTS can significantly decrease ICP and improve CBF in patients with poor-grade subarachnoid hemorrhage and may be used for reversal of pathophysiologic changes caused by cerebral ischemia.

Objective To examine the practicability and security of the LigaSureTM vessel-sealing system in radical gastrcctomy.Methods Seventy patients of stage Ⅰ～Ⅲ gastric cancer undergone radical gastrectomy were analyzed retrospectively.Thirty-five radical gastrectomy were performed with LigaSureTM vessel-sealing system,the other 35 eases were performed without LigaSureTM.The operative duration,volume of intraoperative hemorrhage,and postoperative complications were analyzed.Results There were significant difference in both operative duration[(159.9±24.7)min vs(172.6±23.7)min,P＜0.05]and volume of intraoperative hemorrhage[(335.7±40.3)ml vs(371.7±43.2)ml,P＜0.01].There was no significant difference in the postoperative complications between LigaSureTM group and conventional method group.All patients recovered without severe postoperative complications.Conclusion Radical resection of gastric cancer using LigaSureTM instead of conventional hand tie method appears to he shorten operative duration,decreased volume of intraoperative hemorrhage.And the technique is convenient and safe.

Objective To investigate changes in the intraocular pressure(IOP) and anterior chamber angle in patients with chronic renal failure before and after hemodialysis. Methods Fifty?eight patients(116 eyes) with chronic renal failure were measured with Goldmann applanation tonometer and anterior segment optical coherence tomograph. The patients were divided into three groups based on gonioscopy results:the narrow angle group(22 eyes),the Iris neovascular group(3 eyes)and the open angle group(91 eyes). IOP was measured by Goldmann applanation tonometer in patients in the three groups before and after hemodialysis. Anterior chamber angle opening distance (AOD) was detected by anterior segment optical coherence tomograph before and after hemodialysis. The blood urea nitrogen,creatinine,albumin were also determined before and after hemodialysis. All changes in the parameters were analyzed with a paired t test. Results The IOP in narrow angle eyes and in neovascular eyes increased significantly after hemodialysis ,while the IOP in open angle eyes showed no significant changes. The AOD decreased significantly after hemodialysis. The blood urea nitrogen and creatinine decreased significantly in 58 patients,while albumin increased after hemodialysis. Conclusion The IOP in narrow angle eyes and in neovascular eyes increased after hemodialysis ,correlating with the resistance increase of aqueous outflow pathway and the change of plasma osmotic pressure. As a result ,it is recommended that the condition of eye of patients with chronic renal failure should be checked ,and patients should receive appropriate controlling measure or treatment before hemodialysis.

Objective:To explore the effect of rhGH on apoptosis and the expression of P53 of IgA plasmocytes of intestinal wall after intestinal ischemia-reperfusion injury and the correlation between apoptosis and the expression of P53.Methods:60 Wistar rats were divided into two groups randomly:experiment group(1.33U/kg rhGH was given q.d) and control group.Each group was divided into 3 subgroups(2,4,6days,respectively).Apoptosis and the expression of P53 in IgA plasmocytes of ileal mucosal were observed.[WTH7X]Results:[WT5”XY](1)Apoptosis of IgA plasmocytes in experiment group was lower than that in control group on 2~ nd ,4~ th ,6~ th day and had statistical significance(P

Objective: To study the etiology, clinical manifestation, diagnosis, treatment and precaution of pulmonary embolism following major surgery of gastrointestinal malignant tumors. Methods: Thirty-two cases of pulmonary embolism following major surgery of gastrointestinal malignant tumors were analyzed retrospectively. Results: The most common clinical manifestations were dyspnea, thoracodynia and palpitation. The D-dimer of all cases was positive. The examination of pulmonary arteriography by spiral computed tomography might assist the diagnosis of the disease. Twenty-two patients were discharged through the treatment of oxygen therapy and anticoagulation. Six patients recovered through the treatment of assisted respiration by respirator, thrombolysis and anticoagulation. Four patients died of respiratory failure. Conclusion: The operation of gastrointestinal malignant tumors can increase the incidence of pulmonary embolism. Arteriography by spiral computed tomography and D-dimer can assist the diagnosis and thrombolysis and anticoagulation were effectivel for the treatment.

Objective To explore the effect of down-regulating survivin expression by RNAi on growth suppression and promotion on apoptosis of human hepatocellular carcinoma cells,in order to supply an effective target and technique for liver cancer gene therapy.Methods The recombinant plasmid of pSU6-si-survivin was constructed,which was transfected into Bel7402 cells.Mock group,negative group and treated group were set up.Using MTT assay the proliferation of transfected cells was investigated,the survivin protein expression level was determined by Western blotting and immunohistochemical staining.Transcription of survivin was detected by semi-quantitative RT-PCR.Flow cytometry(FCM) and AO/EB double dyeing were used to examine apoptosis in transfected cells.Results MTT assay demonstrated that the cell growth inhibition rates(%) of transfected cells in treated group at 24,48 and 72 h were 21.43?1.67,39.07?3.80,and 59.72?7.05,there were significant differences compared with negative group(P