Objective To evaluate the mid- and long-term results of coronary artery bypass grafting (CABG) in patients with severe left ventricular systolic dysfunction. Methods Between January 1988 and December 2002, 34 cases with left ventricular ejection fraction (LVEF) less than 0.30 underwent CABG. They were aged 41 to 73 years [mean, (58.0?9.4) years], and 30 of them were male. Coronary angiography revealed LVEF was 0.15 to 0.30(mean, 0.27?0.04), and triple-vessel disease in 31 cases, and left main stem disease in 4. Preoperative echocardiographic examinations revealed a mean of left ventricular diastolic dimension (LVDD) (61.5?8.9) mm and LVEF 0.28?0.07. New York Heart Association (NYHA) class was (2.9?0.7). Off-pump CABG was performed in 8 cases. The number of grafts used ranged from 2 to 6 (3.9?0.9). 32 patients (94.1%) were followed up for 3.5 years (with 7.2 years maximum). Results No patients died in hospital. Heart failure as the main postoperative complications were observed in 5 (14.7%) patients. Postoperative echocardiographic examinations revealed a mean LVDD of (55.2?7.1) mm and LVEF of 0.47?0.11. NYHA class was1.9?0.3 postoperatively. In the follow-up period [mean (3.5?1.9) years], 3 patients died. The survival rates were 91.9% at 3 years and 85.7% at 5 years. Functional status improved significant in left ventricular end-diastolic diameter and left ventricular ejection fraction. There was significant improvement in mean NYHA from class 2.9?0.7 to 1.4?0.6 postoperatively. 26 survivors (81.3%) are free of angina. Conclusion Observations suggest that CABG may offer a better quality of life in patients with poor ventricular systolic function in mid- and long-term follow-up. Preoperative management was the key point of the survival advantage.

Maxillary first molar with twin-root canal in palatal side is rare. This article described two cases of maxillary first molar with twin-root canal. A properly designed and prepared access of the cavity is helpful for the diagnosis and negotiation of the root canal morphology.
Dental Pulp Cavity ; Humans ; Maxilla ; Molar ; Root Canal Therapy

Objective:To study the effect of Fragmin in treatment of unstable angina (UA).Methods:100 patients with UA were randomized into treatment group and control group.In the control group,the subjects were given routine drugs such as sorbitrate,nifedipine and aspirin,while those in the treatment group given fragmine in addition to the routine drugs.Results:The response rates in the treatment and control groups were 82.1% and 54.5%,respectively (P＜0.01).The total effective rates in the treatment and control groups were 92.9% and 63.6%,respectively (P＜0.01).The total effective rate of EKG improvement in the treatment and control groups were 80.4% and 50.0%,respectively (P＜0.01).Conclusion:Fragmin is effective in the treatment of UA.

AIM:To investigate the effect of hydrogen sulfide (H2S) on the expression of MAPKs and ileal epithelial cell apoptosis in the rats with intestinal ischemia-reperfusion ( I/R) injury.METHODS:Healthy female Wistar rats were randomly divided into sham operation group, I/R group, I/R+sodium hydrosulfide ( NaHS) group .The animal model of intestinal ischemia reperfusion was established.Apoptosis index ( AI) of ileal epithelial cell was measured by TUNEL assay.H2 S was detected by sensitive sulfide electrode.The mRNA expression of ERK, JNK and p38MAPK was detected by RT-PCR.The protein levels of phosphorylation( p)-ERK, p-JNK, p-NF-κB P65 and p38MAPK were deter-mined by Western blot.RESULTS:H2 S, ERK mRNA and p-ERK in I/R group were significantly higher than those in I/R+NaHS group and sham group while JNK mRNA, p38MAPK mRNA, p-JNK, p-p38MAPK, p-NF-κB P65 and AI were predominantly higher than those in I/R+NaHS group and sham group (P<0.01).CONCLUSION:H2S attenuates ileal epithelial cell apoptosis in the rats with intestinal I/R injury by down-regulating ERK mRNA p-ERk and up-regulating JNK mRNA, p38MAPK mRNA and phosphorylation of JNK, p38MAPK and NF-κB P65.

Objective To study the change in endogenous hydrogen sulfide (H2S) in patients with acute pancreatitis and its relationship to coagulation function. Methods A prospective case control study was conducted. Forty patients with mild acute pancreatitis (MAP group) and 40 with severe acute pancreatitis (SAP group) admitted to Yiwu Central Hospital in Zhejiang Province from December 2002 to March 2015 were enrolled. Forty healthy persons served as control (healthy control group). Blood was collected to determine the levels of H2S, blood coagulation factor Ⅷ (FⅧ), von Willebrand factor (vWF), plasminogen (PLG), antithrombin (AT), platelet count (PLT), tissue factor (TF), tumor necrosis factor-α (TNF-α), and protease activated receptor-1 (PAR-1). The correlations among the above parameters were analyzed. Results There was no statistical significance in sex, age, body weight and time of disease among three groups, indicating it was comparable among the groups. Compared with healthy control group, the levels of H2S, FⅧ, vWF, TF, TNF-α, and PAR-1 in MAP and SAP groups were significantly elevated [H2S (μmol/L): 67.42±6.34, 112.47±12.69 vs. 42.57±4.18, FⅧ: (67.5±5.8)%, (82.3±4.7)% vs. (57.2±6.4)%, vWF: (112.6±9.7)%, (142.5±12.5)% vs. (76.4±8.2)%, TF (ng/L): 45.27±4.34, 64.76±6.25 vs. 18.15±1.89, TNF-α (ng/L): 197.67±13.62, 324.72±25.54 vs. 20.08±2.57, PAR-1 (fluorescence intensity): 32.16±4.43, 56.12±7.07 vs. 12.27±2.12, all P < 0.01], and PLG and AT activity were significantly decreased [PLG: (52.4±4.7)%, (36.7±3.2)% vs. (62.1±5.6)%, AT: (43.2±6.9)%, (35.5±5.4)% vs. (53.6±6.1)%, all P < 0.01]. The changes in the parameters in SAP group were more remarkable than those in MAP group (all P < 0.01). PLT in SAP group was significantly lower than that in healthy control and MAP groups (×109/L: 8.5±1.1 vs. 15.7±2.8, 12.4±1.9, both P < 0.01). H2S was positively correlated with FⅧ, vWF, TF, TNF-α, and PAR-1 (r value was 0.56, 0.61, 0.72, 0.66, 0.64, respectively, all P < 0.01), and it was negatively correlated with PLG and AT (r value was -0.64, -0.57, both P < 0.01). Conclusion As an inflammatory factor, endogenous H2S deteriorates coagulation function in patients with acute pancreatitis by up-regulating TF, TNF-α, and PAR-1.

[Objective]To investigate the treatment of nonunion after Pilon fracture with fibula approach fixation of tibia and ankle joint fixation and its clinical efficacy.[Method]Six cases of nonunion after Pilon fracture were collected from 1999 to 2004,which included 4 males and 2 females,with the average age of 34.7 years(21~53 years).All fractures were found invasion to the tibia-fibula joint and ankle malformation.Fibula and tibia were opened from posterolateral approach and reconstruction plate was placed laterally on the fibula,with screws crossing the fibula into the tibia directly.Autogenous bone graft was used in fracture position and area between tibia and fibula to gain tibia-fibula fusion.[Result]All cases were followed up from 8 months to 4 years with the average of 22 months.Bone fusion were gained in 5 cases with the average time of 3.5 months.Plate broken was found in 1 case for too early weight bearing.[Conclusion]Fibula approach fixation of tibia and ankle joint fixation has advantages of promoting fracture healing,preventing complications,and correction joint malformation.It is a convenient and reliable method for clinical surgeons.

[Objective]To summarize the experience about treatment of segmental and comminuted femoral fractures with intramedullary nail in multiple injuries.[Method]From March 2002 to July 2006,28 patients with segmental and comminuted femoral fractures were treated surgically,13 with AO type C1,9 with C2 and 6 with C3.All of the fractures were treated with close reduction static intramedullary nail fixation.[Result]The postoperative follow-up ranged from 11 to 34 months with an average of 21 months.All of the fractures were healed.Limit load was required for 5 patients who had delayed union without special treatment.After 18-30 months the patients healed up.There were no fat embolisms.No complications such as infection,intramedullary bending or break occurred.[Conclusion]Treatment of femoral fractures with intramedullary nail is a standard method.However,to achieve satisfactory results,comprehensive treatment,careful planning and procedure should be taken for segmental and comminuted femoral fractures in multiple injuries.

0.05).Conclusion The immunofunction was impaired considerably by chemotherapy.Rhodiola L.can enhance the immunofunction considerably.

Objective To study the primary volume of bone cement and the method of perfusion and the clinical effect of percutaneous vertebroplasty for bone metastatic tumors. Methods Percutaneous vertebroplasty was performed in 218 vertebral bodies of total 150 patients,including 92 males and 58 females with age of 26-85,averaging 56.8 y. 218 vertebral bodies included 73 dorsal vertebra and 138 lumber vertebra and 7 sacral vertebra. Operations were taken under the DSA monitoring. The approach route was selected according to the morphology of the vertebrae,damage extent and puncture site. Results Operation was successful in all 218 vertebrae of total 150 patients with a ratio of 100%. The primary volume of bone cement needed to fill dorsal vertebra was 2-5 ml,average 3.5 ml; that for lumber vertebra was 3-8 ml,average 5.5 ml; and that for sacral vertebra was 4-7,average 5.5 ml. 134 patients showed total pain relief (89.3%); 15 patients had partial remission (10%) and 1 failure (0.7%). The cement extravasated to intervertebral disk in 12 patients,to scleromeninx capsula externa in 10,to para-vertebra plexus venosus in 3 and to paravertebra soft tissue in 4. The incidence of leakage of bone cement was 13.3%,but no complications occurred during and after the operation. Concolusion Percutaneous vertebroplasty provides obvious pain relief effect for vertebral metastasis,worthy to be recommended widely in clinical application.

Objective To explore the possibility of expending indications of VATS though auxiliary mini-incision. Methods 54 patients with thoracic injury underwent pulmonary lobectomy or pulmonary wedge resection or pulmonary rupture repair or diaphragm rupture repair using VATS combined with auxiliary mini-incition. Results All of 54 patients were cured. with primary wound healing .Hospital stay was 8d~10d with a mean of 10d.. No complication occurred. Conclusions VATS combined with auxiliary mini-incision could provide a possibility of simultaneous diagnosis and treatment and obtains as the same therapeutic result as conventional open surgery and expends indication of VATS.