Objective To explore the clinical effect of surgery on treating multi-extensively drug resistant (MDR) and extensively drug resistant pulmonary (XDR) tuberculosis (M/XDR-PTB) in order to provide the new approach for patients with M/XDR-PTB.Methods The information of 75 cases with M/XDRPTB were recorded and they were underwent thoracic surgery at the National Tuberculosis Center in Tbilisi,Georgia from October 2008 to February 2011.Results Of 75 patients,52 cases were MDR and 23 were XDR with PTB underwent adjunctive thoracic surgery.The following surgical procedures were performed including pneumonectomy(10％),lobectomy (51％),segmentectomy (33％).Median age was 30 years and average duration of preoperative M/XDR-PTB medical therapy was 350 days.Mean postoperative follow up period was 372 days.Of 72 patients with complete outcomes information,59 (82％) had favorable outcomes including 90％ of MDR and 68％ of XDR-TB patients.No postoperative death occurred,7 patients (9％) had postoperative complications.Univariate analysis showed that,compared with good treatment outcomes,risk factors of poor treatment outcomes included cavitary disease (62％ vs.27％,P =＞ 0.02),probability of suffering from XDR (62％ vs.27％,P =0.02),positive preoperative sputum culture (77％ vs.14％,P＜ 0.001),acceptance of sensitive drugs(1.9％ vs.2.8％,P =0.03) and major postoperative surgical complication (23％ vs.5％,P =0.03).Conclusion Patients with M/XDR-PTB undergoing adjunctive thoracic surgery show with high rates of favorable outcomes,and no surgical related death as well as the low complications rates.Adjunctive surgery appears to play an important role in the treatment of select patients with M/XDR-PTB.

Objective To observe the clinical efficacy of comprehensive muscle-region therapy based on Chuang Medicine in treating cervical spondylosis of neck type.Method A hundred patients with cervical spondylosis of neck type were randomized into a treatment group and a control group, 50 cases in each group. The treatment group was intervened by the comprehensive muscle-region therapy based on Chuang medicine (muscle-region tuina, fire-needle acupuncture of Chuang medicine, and cupping), while the control group was by regular acupuncture treatment. The Visual Analogue Scale (VAS) score and symptoms and signs scores were observed before and after intervention, and the clinical efficacies were compared.Result The VAS scores respectively after 1 and 2 treatment courses were significantly different from that before intervention in the treatment group (P<0.05,P<0.01). The VAS score after 2 treatment courses was significantly different from that before intervention in the control group (P<0.05). After 2 treatment courses, the VAS score in the treatment group was significantly different from that in the control group (P<0.05). After treatment, the symptoms and signs scores (pain intensity, pain-affected area, number of tender points, limited motion, and general score) were significantly different from that before intervention in the treatment group (P<0.01, P<0.05). In the control group, the pain intensity, limited motion and general score after treatment were significantly different from that before intervention (P<0.05,P<0.01). After treatment, the symptoms and signs scores in the treatment group were significantly different from that in the control group (P<0.05,P<0.01). The total effective rate was 100.0% in the treatment group versus 84.0% in the control group, and the difference was statistically significant (P<0.05).Conclusion Comprehensive muscle- region therapy in Chuang medicine is an effective approach in treating cervical spondylosis of neck type.

To investigate the therapeutic effect of peroxiredoxin-6(PRDX6)on ultraviolet-induced corneal injury in rats and explore the mechanism.The rat model of corneal injury was established by exposing to ultravio-let.Male wister rats were randomly divided into control groups,dexamethasone (DXM)groups and PRDX6 groups,the rats were administered four times a day and for 12 days.The corneal opacity was observed with a slit-lamp microscope.Histopathologic changes were observed with light microscopy.The content of corneal malonalde-hyde(MDA)was determined by thiobarbituric acid test and the total antioxidative capacity(TAOC)was detected by chemical colorimetric test.P38 MAPK signal pathway was detected with the method of Western blot and the gene expression of cytokines were measured by RT-PCR method.Compared with the control group,PRDX6 treat-ment significantly reduced corneal opacity,improved corneal pathology injury,decreased the MDA content and in-creased the TAOC.In the PRDX6 group the level of phosphorylated p38 protein was significantly lower than that in the control group.The gene expression of cytokine were different between control and PRDX6 groups(P <0.05).PRDX6 showed therapeutic effect in the rat model of ultraviolet-induced corneal injury.This maybe be concerned with that it could alleviated the oxidative damage,suppressed p38 MAPK phosphorylation and regulate the gene expression of cytokine.

Objective The optimal treatment for chronic type B dissection remains controversial. The purpose of this study was to report early and mid-term results of thoracic endovascular aortic repair (TEVAR) of chronic type B aortic dissection. Methods Methods From June 2001 to September 2007, 84 patients with chronic type B aortic dissection received TEVAR. The time between onset of dissection and TEVAR was (13.9 ± 22.0) months (ranged 1 - 120 months). All patients were followed for 6 - 86 months [mean (33.2 ± 19.2) months]. Results The entry tear was completely sealed in 77 cases ( 91.7% ) during TEVAR. The incidence of incomplete seal was 8.3%. One-month mortality was 1. 2%. One patient had retrograde type A dissection 1 month after operation. Four patients received a second TEVAR during follow-up :3 for endoleaking and 1 for newly formed intima tear. Seven patients (8.3%) died during follow-up: 3 thoracic aorta rupture due to endoleaking, 1 abdominal aorta rupture caused by continuous dilation of the abdominal aorta, unrelated to aortic dissection deaths in 2 and 1 died of unknown cause. The Kaplan Meier actuarial survival curve showed a 7-year survival rate of 84.4%. Conclusion Early and mid-term results showed that TEVAR was effective in treating chronic type B aortic dissection. Endoleak was the main cause of death during follow-up. With increasing of physician's experience and refinement of the stent-graft, results are likely to improve in the future.

Objective To construct expression vectors of calmodulin(CaM)mutants N2 and C2,and to express,purify,and identify the mutant proteins,in order to study the interactions between CaM and calcium channels. Methods The cDNA of N?lobe and C?lobe of CaM were used to prepare the cDNA of N2 and C2. Next,the recombinant cDNAs were cloned into a pGEX?6p?3 plasmid,and the recombinant plasmids were trans?ferred into E.coli BL21 cells. The transfected BL21 cells were stimulated with IPTG. The fusion proteins were extracted by ultrasonication and puri?fied by using GS?4B beads. Finally,protein activity was identified by the pull?down assay. Results Both the restriction digestion map and the DNA sequence identification results confirmed that the recombinant plasmids were successfully constructed. SDS?PAGE results showed high purity and concentration of N2 and C2 proteins. Their activities and binding abilities with the calcium channel fragment were confirmed by the pull?down assay.Conclusion In this study,expression vectors of N2 and C2 are successfully constructed,and physiologically active N2 and C2 CaM mutant proteins are obtained.

Objective To evaluate the feasibility of apply Ion Proton semiconductor sequencing platform in non-invasive prenatal genetic diagnosis .Methods Totally 1 000 pregnant women with a singleton pregnancy of 12-32 weeks gestation were selected from the Third affiliated Hospital of Zhengzhou University from Jan to Dec 2013.Using noninvasive prenatal genetic diagnosis based on Ion Proton semiconductor sequencing platform to study their cffDNA .In parallel, 72 pregnant women received invasive prenatal diagnosis by traditional chromosomal analysis with amniocentesis chorionic villus sampling .Results It′s shown that 18 out of 1 000 (1.8%) pregnant women underwent the noninvasive prenatal genetic testing had a high risk for aneuploid chromosomes , including 7 cases of 21-trisomy, 4 cases of 18-trisomy, 2 cases of 13-trisomy, 4 cases of sex chromosomal abnormality , and 1 case of 15-trisomy.It demonstrated that the rate and accuracy of fetal 21-trisomy, 13-trisomy and 18-trisomy by non-invasive prenatal genetic testing were both 100%without misdiagnosis , the rate of detection for sex chromosomal abnormality was 2/2 with a false positive rate of 1/3.However, the 15-trisomy predicted by the non-invasive prenatal diagnosis in a woman was finally proved to be a false positive .Based on the results by karyotyping (55/55) as well as follow-ups (493/493), the specificity of the non-invasive prenatal diagnosis for detection of 21-trisomy, 18-trisomy and 13-trisomy was 100%.One Ion PITM chip could detect 12 to 15 samples in 1.5 h and the whole process of noninvasive detection could be completed in 1 to 1.5 days.Conclusions The non-invasive prenatal diagnosis by Ion Proton semiconductor sequencing platform could provide fast and accurate detection of fetal aneuploidy .The benchtop high-throughput sequencing platform has laid the foundation for the independent application in clinical settings for fetal aneuploidy detection .

Objective To evaluate the effect of clopidogrel premedication on in-hospital major adverse cardiovascular and cerebral events (MACCE) and bleeding outcomes before coronary artery bypass graft surgery (CABG). Method A total of 2021 patients who underwent CABG from July 2003 to September 2005 were divided into either clopidogrel ( n = 479) or no clopidogrel (1542) group before CABG. Patients with clopidogrel administration ( n = 479) were subdivided into < 5 d ( n = 154) ,5～7d(n = 183)and >7d(n = 142) group according to timing of clopidogrel withdrawal before surgery. In-hospital MACCE and perioperative bleeding outcomes were analyzed among groups. Results Patients who took clopidogrel before surgery had nonsignificantly rates of bleeding and in-hospital MACCE compared with those patients not administered clopidogrel. No differences were found about the incidence of total bleeding,minor bleeding,transfusions of red blood cells,fresh frozen plasma,whole blood and in-hosptial MACCE among three subgroups.The < 5 d group had higher incidence of major bleeding and more platelets transfusions than 5 ～ 7 d [47.8% vs. 31.9%,P < 0.017; (0.08 ±0.38) U vs. (0.00±0.00) U,P <0.017,respectively]and >7 d group [47.8% vs. 20.3%,P <0.017; (0.08±0.38) U vs. (0.00±0.00) U,P <0.017,respectively). However,there were no significant differences between 5 ～ 7 d and > 7 d group ( P > 0.05). Conclusions Gopidogrel administration before CABG does not increase the incidence of in-hospital MACCE events. However,the perioperative risk of bleeding will rise if the patients withhold clopidogrel less than five days before surgery.

Objective To identify the electrophysiological charateristics and cause of ridge gap related reentry after MI ablation in atrial ifbrillation patients. Methods Activation and entrainment mapping was performed in 82 redo cases for OAT recurrence in whom MI was ablated during the index produre. Once ridge gap related reentry was conifrmed, detailed mapping was performed in MI and ridge region. In addition, in 36 cases undergoing MI ablation and fulfilling criterion for bidirectional block, differential pacing was repeated at the ridge to identify a ridge gap. Results Out of 82 redo cases for OAT recurrence in whom MI was ablated during the index produre, 7 (8.5%) was found to be ridge gap related reentry. TCL was (247.9±19.2) ms, and the left atrial endocardial activation time was (145.4±17.7) ms, accounting for (58.5±3.2)%of TCL. However, wide double potential was recorded along the previous ablated MI line where PPI was (34.3±6.6) ms longer than TCL, while PPI was signiifcantly shorter at the ridge[PPI-TCL (11.4±3.9) ms, P<0.001]. Tachycardia was terminated at the ridge in 6 cases and at the corresponding site in coronary sinus in 1 case. No recurrence was found during follow-up for (11.1±4.5) months. In addition, in 36 patients undergoing MI ablation in whom criterion of bi-directional block was fuliflled, conduction gap located at the ridge was found in 5 (13.9%) cases. Conclusions MI ridge gap related reentry is a distinctive OAT, in which the ridge was used as the critical isthmus, whereas the previous ablated MI line is not part of the reentry. MI pseudo-block due to the ridge gap may lead to this type of recurrent tachycardia.

Objective Identify the mechanism of induced atrial arrhythmias after pulmonary vein isolation (PVI) in patients with paroxysmal atrial ifbrillation(PAF), and investigate its long-term prognosis. Methods All patients with PAF undergoing PVI and induction test afterwards between Feburary 2010 and October 2010 were included. The induction protocol was rapid pacing initiated at cycle length of 250 ms with progressive shortening in a decrement of 10 ms down to 180 ms or refractoriness. Isoproterenol of 2-4μg/min was administrated as well. Inducibility was deifned as induction of atrial arrhythmia lasting >1 min. The mechanism of induced tachycardia was identiifed by activation mapping and entrainment mapping under the guidance of CARTO system. All patients were followed up by 36 months. Results Forty-nine atrial tachycardia were induced in 39 (19.7%) patients, including 35 organized atrial tachycardia (OAT) and 14 atrial ifbrillation (AF). The LA diameter was signiifcantly larger in inducible group than non-inducible group (39.5±6.6 mm vs. 36.7±5.2 mm, P=0.004). Macroreentry was the most common mechanism in induced OATs (28, 80.0%), and mitral isthmus was the most common critical site (20, 40.8%), followed by cavo-tricuspid isthmus (12, 24.5%), PV (6, 12.2%), LA septum (4, 8.2%), superior vena cava (3, 6.1%) and LA roof (1, 2.0%). Conclusions The most common mechanism of induced tachycardia by IV isoproterenol and rapid pacing is MI and CTI dependent after PVI in PAF patients, which can be succssefully eliminated by liner ablation, not increasing long-term recurrence rate.

Objective To investigate the effect of capsaicin on cognitive function and the expression of TRPV1 protein in hippocampus of rats with chronic cerebral hypoperfusion (CCH).Methods 60 SD rats were randomly divided into control group (SHAM group),chronic cerebral hypoperfusion group (CCH group),placebo control group(PC group) and capsaicin group(CAP group) with 15 in each group.The chronic cerebral hypoperfusion rat model was established by permanent bilateral common carotid artery occlusion.The rats in CAP group and PC group were given capsaicin and saline respectively by intraperitoneal injection,twice a week.The spatial learning and memory ability and emotion of rats were observed by Morris water maze test and open field test,and the expression of TRPV1 in the hippocampus of rats was detected by Western blot.Results (1) In the open field experiment,compared with the SHAM group (22.60±4.60),the standing times of the CCH group(12.10±2.80) decreased (P＜0.01),but the standing times of CAP group (19.30± 4.16) increased compared with that of h PC group(12.50 ±2.68) (P＜0.01).(2) In Morris water maze test,positioning navigation experiment showed that compared with the SHAM group,the escape latency of the CCH group and the PC group increased (P＜0.05),while the escape latency of CAP group was shorter than that of the PC group (P＜ 0.05).And in the space exploration experiment,compared with the SHAM group (1.87 ± 0.64),the times of crossing the platform in CCH group (0.75 ± 0.89) and the PC group (1.00± 0.93) decreased,while the latency of crossing the platform increased (P＜0.01).And the times of crossing the platform in CAP group((2.38±0.74) increased compared with that of PC group,and the latency of crossing the platform of CAP group decreased compared with that of PC group (P＜0.01).(3) Results of Western blot showed that compared with the SHAM group,the level of TRPV1 in rat hippocampus of CCH group was down regulated (P＜0.05),and the expression of TRPV1 in CAP group was higher than that of PC group (P＜0.05).Conclusion Capsaicin can effectively improve cognitive impairment in rats with chronic cerebral hypoperfusion,which may be related to the up-regulation of TRPV1 protein expression in hippocampal tissues.