Objective To investigate the prevalence rate of senile insomnia and revealing the characteristics of its pathogenesis. Methods On the basic study of senile insomnia clinical literature, the questionnaire was made and followed by epidemiological investigation. The database was set up for statistical analysis with SPSS13.0. Results Prevalence rate of senile insomnia in Wuchang District of Wuhan City was 36.47%. There were significant difference in sleep time, the length of sleep at night, sleep continuity especially mental state during the day between insomnia group and the normal group (P

Objective:To explore the value of magnetic resonance imaging (MRI) parameters combined with serum macrophage migration inhibitory factor (MIF) and microRNA-1203 (miR-1203) in the early diagnosis of hepatocellular carcinoma (HCC) and its relationship with efficacy.Methods:From October 2017 to October 2019, 100 patients with HCC in Hunan Provincial Hospital of Traditional Chinese Medicine were selected as the observation group. 92 patients with benign liver tumor and 102 healthy people were randomly selected as the control group and normal control group. The clinicopathological features, MRI parameters [hepatic artery perfusion index (HPI), volume transfer constant (K trans)], serum MIF and miR-1203 levels were compared among the three groups; the value of MRI parameters, serum MIF and miR-1203 in single and combined diagnosis of HCC was explored; the relationship between each index and curative effect of HCC patients was analyzed. Results:The levels of HPI, K trans, serum MIF and miR-1203 in observation group were higher than those in control group and normal control group ( P<0.05); There were significant differences in HPI, K trans, serum MIF and miR-1203 levels among patients with different tumor length, differentiation degree, Child Pugh grade and distant metastasis in the observation group ( P<0.05). Among HPI, K trans and serum MIF, miR-1203, the specificity of HPI and K trans for diagnosis of HCC were the largest (94.57%), and the sensitivity of K trans for diagnosis of HCC was the largest (75.00%); the area under the curve (AUC) of the combined diagnosis of HCC was 0.879, which was greater than the AUC of the single diagnosis of HPI, K trans and serum MIF, miR-1203 (0.753, 0.793, 0.792, 0.809); the optimal sensitivity and specificity of the combined diagnosis were 79.00% and 86.96%, respectively; the levels of HPI, K trans, serum MIF, and miR-1203 in effective patients in the observation group were lower than those in the ineffective patients after treatment ( P<0.05); the clinical efficacy of HCC patients were significantly correlated with the levels of HPI, K trans, serum MIF and miR-1203 ( P<0.05). Conclusions:The MRI parameters HPI, K trans and serum MIF, miR-1203 levels in patients with HCC increased significantly, which has high application value in assisting clinical diagnosis of HCC, and is closely related to the clinical efficacy of patients, and has great development potential in efficacy evaluation.

Objective The aim of this study is to summarize primarily the application range and the clinical effect of the minimally invasive direct cardiac surgery (MIDCS).Methods From April 2010 to August 2011,108 operations had been performed in our centre using MIDCS,among of which 44 males and 64 females,mean age (44.3 ± 16.4 ) years old,mean weight (60.0 ± 12.0 ) kg.These operations included 29 MVR operations (replacement with mechanical valve 19,with tissue valve 10),17 AVR operations( replacement with mechanical valve 11,with tissue valve 6 ),5 MVP operations,6 MVR + AVR operations (replacement with mechanical valve 5,with tissue valve 1 ),12 VSD repair operations and 23 ASD repair operations,9 MIDCAB operations,1 MVR + CABG oparation,2 PECD correction,1 repair of ruptruec chordae tendineae of tricuspid septum and 1 Ebstein deformity correction operation.Concomitant procedures included 19 TVP operations and 11 radiofrequency ablation operations.Except MIDCAB operations,other operations are performed with closed type extracorporeal circulation.Conversion to median sternotomy was necessary in only two patients ( 1.9％ ).Results Mean cardiopulnonary bypass time and aortic eross-clamp time were ( 104.4 ± 59.3 ) minutes and ( 66.7 ± 52.8 ) minutes respectively,74 patients ( 92.5 ％ ) recover to beat automatically after heart ceased operation.Median mechanical ventilation time was ( 14.5 ± 11.9 ) hours,Median intensive care unit stay was ( 18.8 ± 15.3 ) hours,median hospital stay post operative was (6.9 ± 2.9) days.Median incision length was (5.3 ± 1.2 )cm.Median draining volume was( 337.6 ± 240.9 )ml in the first day after operation,No transfusion occurred in 72 patients(66.7％ ).Hospital mortality was 0.No re-exploration for bleeding and sternal wound infection.When leaving hospital,94 being of heart functional class Ⅰ,8 of class Ⅱ,6 of class Ⅲ.Conclusion MIDCS was associated with good operative effect in the near future,superior safety and broad application range.Furthermore MIDCS has minimally invasive,less postoperative bleeding,fewer blood transfusions,good cosmesis,as well as the absence of sternal wound infection.It may be safely performed on selected patients with low postoperative mortality and morbidity.

Cell therapy has a very promising potential for end-stage liver diseases (ESLD).Fetal liver stem/progenitor cells (FLSPCs) have advantages of safety,high survival and proliferation rates,and a small volume,all which make them ideal for liver disease stem cell therapy.During the early phase of our study,we applied a three-step separation method to enrich FLSPCs and obtained a separation efficiency similar to that of the flow-cell sorting method.Additionally,using a fulminant hepatic failure model in rats,we have demonstrated that FLSPCs can contribute to morphological and functional recovery of the liver.This manuscript will discuss how FLSPCs can be induced to accurately differentiate into hepatocytes and cholangiocytes and how FLSPCs maintain self-renewal.The Notch signaling plays a critical role in regulating the differentiation and self-renewal of many types of stem cells.Our previous findings have shown that the Notch signaling plays an important role in FLSPCs differentiation into hepatocytes.Therefore,the Notch signaling might be involved in the differentiation and self-renewal of FLSPCs.We conducted a study on the regulatory effects and relative molecular mechanisms of the Notch signaling on FLSPCs and found the corresponding interfering target,which might become an index for the clinical application of FLSPCs.

Objective To investigate early and midterm outcomes after minimally invasive1-stop or 2-stage MICSCABG and PCI hybrid surgery.Methods Between June 2011 and February 2015, 28 patients(19 males and 9 females) with multiple coronary artery disease underwent MICS-CABG and PCI hybrid surgery, 4 cases of which were1-stop hybrid surgery and 24 cases were 2-stage.All patients were followed up to major adverse events(recurrent angina, secondary myocardial infarction, congestive heart failure, serious arrhythmias, secondary bypass graft) as the end point event.Results All patients were no perioperative deaths, shock, infection and myocardial infarction.ICU stay time was(22.9 ± 12.5) h, hospital stay time was(6.75 ±2.10) days, intubation time was(21.1 ± 17.7) h.Perioperative1-stop and2-stages hybrid surgery had significant statistical differences in ICU stay time and intubation time[(41.8 ±32.9) h vs.(16.5 ± 8.5) h;(40.0 ± 34.2) h vs.(18.8 ± 8.5) h;P ＜ 0.05].Patients were followed up for 1-44 months, averaged (17.9 ± 12.8) months.The postoperative major adverse event rate was 7.14％, one patient died of cerebral hemorrhage after 6 months, and one patient underwent coronary angiography because angina.Conclusion l-stop or 2-stage MICS-CABG and PCI hybrid surgery provides a safe,effective and cosmetic revascularized method to patients with multiple coronary artery disease.Meanwhile,the procedure does not destroy the way of re-operation.The perioperative and early results of follow-up are satisfactory.

Objective To observe the effects of wild jujube seed decoction (WJSD) on learning memory and the levels of malondialdehyde (MDA) and the activities of supemxide dismutase (SOD) and nitric oxide synthase (NOS) in the brain of the pathogeny model rats with sleep deprivation (SD). Methods Levels of learning memory and MDA, and activities of SOD and NOS in rats' brain were assayed after SD induced by made-self multiple platform method ( MMPM), senescence induced by D-galactose, and Yin and blood-deficiency induced by eyclophosphamide and hydrocortisonum. Results After 48 h SD, the levels of learning memory was lower in the model group( ( 108.9 ± 12.5 ) s, ( 89 ± 11.5 ) s, ( 0 ) ) than those in the environmental control group ( ( 47.3 ±4.6)s,(9±1.4)s,(6.5 ±1.2))(( t=4.36,3.18,2.07, P＜0.01＝＝. While MDA, and activities of SOD and NO in rats'brain higher in the model group( (3.8 ±0.6) ,(3.0 ±0.5)nmol · mgprot-1 ,(229.7 ±25.8) ,(236.3± 25.2 ) U · mgprot - 1, ( 5.7 ± 0. 8 ), ( 5.4 ± 0.9 ) U · mgprot - 1 ) than those in the environmental control group ( (2. 1 ±0.4) ,(1.6 ±0.4)nmol · mgprot-1 ,(155.5 ±10.6) ,( 147.2 ±26.1 )U · mgprot-1 ,(2.8 ±0.7),(2.9 ± 0.5 ) U · mgprot -1 ) ( t = 2.89,3.01,6.78,5.94,3.10,3.46, P ＜ 0.05 ＝. However, the observation of the groups treated with WJSD, the levels of learning memory showed a tendency in returning to normal level (P ＜ 0.05 ＝ ,and MDA, and activities of SOD and NO of the high dose of WJSD showed a tendency in returning to normal leve1 (P ＜ 0.05 ＝ ,and the low dose of WJSD showed a tendency in returning to normal level too(P ＜ 0.05 ＝. Conclusion WJSD can improve the disability of learning and memory of the pathogeny rats model, and its one of mechanism maybe involve the reduction of neural cell damage with free radical and NO.

Objective To summarize the short-term therapeutic results of valve-sparing reimplantation procedure (David Ⅰ procedure) using Valsalva conduit in patients with aortic valve insufficiency due to aortic root disease.Methods From January 2008 to May 2011,David Ⅰ procedure was performed using Valsalva conduit in 15 patients with aortic insufficiency caused by aortic root disease,of which 14 males and 1 female,mean age was (49.5 ± 10.3) years old (from 33 to 67 years old).The evaluation of pre-operative heart functional and aortic valve regurgitation:11 in class Ⅰ,4 in class Ⅱ ; 9 with moderate and 6 with severe aortic insuffciency.Concomitant procedures included 4 CABG operations,9 aortic arch replacements,1 mitral annuloplasty and tricuspid annuloplasty,and 1 ASD repair operation.Results There was two intra-operative deaths occurred,one died of pulmonary infection,another one died of hemategenous septic shock and multiple organ failure.The mean extracorporeal circulation time was (230.0 ± 54.4) min,the aortic cross clamp time was (181.2 ± 30.6) min.One week after operation,the heart functional of all patients changed into class Ⅰ ; 8 patients had no aortic regurgitation,6 had gentle aortic regurgitation and 1 had moderate aortic regurgitation.After leaving hospital,13 patients were followed-up by (8.8 ± 5.9)months (ranged 3 to 24 months),3 were no and 9 with gentle (3 of which showed no aortic regurgitation in half past year)and 1 with moderate aortic regurgitation (this patient showed gentle aortic regurgitation in 3 months later).Conclusion David Ⅰ procedure using Valsalva conduit was a good option for patients with aortic valve insufficiency with approximate normal aortic leaflets and valvular ring,which could provide a good short-term operative effect.

Objective To observe the clinical results of the valve-sparing root reimplantation procedure(David Ⅰ procedure) in patients with aortic valve insufficiency due to aortic root disease.Methods From august 2005 to May 2011,aortic valve-sparing root reimplantation was performed in 24 patients with aortic insufficiency due to aortic root disease,21 males and 3 females; mean age (47.0 ± 12.3) years old (from 24years to 69years) ; 20 being of heart functional class Ⅰ,3 of class Ⅱ,and 1 of class Ⅲ; 13 with moderate and 11 with severe aortic insufficiency ; The tubular graft was used in 9 patients and valsalva conduit was used in15 patients in David Ⅰ procedure.Concomitant procedures included 6 CABG operations,11 aortic arch replacement operations,1 mitral annuloplasty and tricuspid annuloplasty,1 VSD repair and 1 ASD repair operation.Conversion to Bentall procedure was necessary in only one patient because transesophageal echocardiography (TEE) showed moderate aortic insufficiency due to aortic valve prolapse.Post-operative aortic valve regurgitation and heart function were followed up.Results There were two peri-operative deathes(one died of pulmonary infection in the 22th day postopertatively,another one died of haemategenous septic shock and multiple organ failure in the 9th day postopertatively),one late death other than operation-related reasons(died of pulmonary infection in the 54th day postopertatively).The mean extracorporeal circulation time was (235.9 ± 58.5) min,the aortic crossclamp time was(182.7 ± 35.8) min.11 patients had no aortic regurgitation,11 gentle and 1 moderate regurgitation postopertatively ; The heart functional of all patients changed into class Ⅰ one week post-operatively.20 patients were followed-up 3 to 74 months,of which 3 with no and 15 with gentle (3 of which showed no aortic regurgitation in half year later) and 2 with moderate aortic regurgitation (1 patient with Marfan syndrome used tubular graft showed severe postopertative aortic regurgitation 55 months later).Conclusion David Ⅰ procedure is a good option for patients with aortic valve insufficiency due to aortic root disease,and with more or less normal aortic leaflets and valvular ring normal.Furthermore using Valsalva conduit in David Ⅰ procedure could provide a more stable mid and long-term effect.

Objective To evaluated the early-term results of the right or left anterolateral minithoracotomy used for the repair of various congenital heart defects.Methods All the patients with congenital heart defects who were operated with this incision between April 2010 and December 2012 were reviewed.There were 63 patients (41 females,22 males) underwent openheart surgery through right or left anterolateral minithoracotomy.Ages ranged from 12 to 69 years,mean (30.63 ± 11.74) years.Corrected defects included atrial septal defect(ASD) closure in 38,closure of ventricular septal defect(VSD) in 19,correction of partial atrioventricular canal defect (PECD) in 3,correction of partial anomalous pulmonary venous connection (PAPVC) in 1,correction of Ebstein's anomalyin 1,and repair of ruptured aneurysm of the sinus of Valsalva in 1.Results In all patients,length of incision was (4.76 ± 0.95) cm.There was no early or late death.No patient required conversion to full sternotomy.The median CPB and aortic clamp times were (76.38 ± 29.97) and (33.49 ± 31.50) minutes,respectively.Median intubation time was (10.53 ± 6.13) hours.Median duration of intensive care and postoperative hospital stay was (14.93 ± 7.65) hours and (5.42 ± 1.98) days,respectively.Only 9 patients(14.3％) received blood transfusion.Follow-up echo showed no residual defect.All patients have gratifying cosmetic results and are in excellent condition after a median follow-up of (13.75 ± 8.91)months.Conclusion The small anterolateral thoracotomy in congenital cardiac surgery is a safe and feasible approach,and with a excellent cosmetic results.

Objective To optimize the concentration of polyethylene glycol (PEG) for the growth of Chlamydia trachomatis (Ct) reference strains D-UW-5/Cx and E-UW-5/Cx,and to evaluate the effects of PEG on the sensitivity of Ct to 4 common antibiotics.Methods After the inoculation of Ct standard strains (D-UW-5/Cx and E-UW-5/Cx) into McCoy cell monolayer,different concentrations of PEG were added into the culture medium followed by centrifugation.After 2 hours of incubation at 37 ℃,the inoculum was removed and a complete culture medium containing 1 μg/mL cycloheximide was added followed by another 48-hour culture.Subsequently,the culture was fixed and subjected to iodine staining for the calculation of Ct inclusions and optimization of PEG for the growth of Ct.Some Ct standard strains were used to infect McCoy cells,with PEG (0.7％,wt/vol) added to the culture medium after inoculation and before centrifugation process,and when the infection rate reached higher than 90％,a microdilution method was utilized to evaluate the minimal inhibitory concentration (MIC) of 4 antibiotics,including azithromycin,minocyline,moxifloxacin and doxycycline.Thirty-one clinical specimens,which had been confirmed to be positive for Ct serovar D or E strain,were inoculated into McCoy cell monolayer for the passage of Ct with or without the presence of 0.7％ PEG.Results The optimal concentration of PEG was 0.7％ for the growth of Ct,and this concentration of PEG could increase the number of inclusion bodies of Ct serovar E by 3.44 folds,and that of Ct serovar D by 3.56 folds.In vitro,the MICs of the 4 antibiotics were consistent between PEG-treated and untreated Ct reference strains.Moreover,PEG notably increased the quantity of inclusion bodies of Ct serovar E or D from clinical specimens after passages.Conclusions PEG (0.7％) can enhance the growth of Ct serovar D and E,but has no obvious influence on antimicrobial susceptibility of Ct.