ObjectiveTo investigate the significance of synchronic heart rate variation(HRV) and blood pressure variation(BPV) in the evaluation of coronary artery disease(CAD).MethodsOne hundred and three patients who received coronary artery angiography were divided by the lesion degree into occlusion group (28 cases with more than 1 complete-occlusion coronary artery),non-occlusion group (45 cases with more than 1 coronary artery stenosis ≥50％ but without complete-occlusion) and control group (30 cases without stenosis ≥50％).Occlusion group and non-occlusion group were divided by lesion location into left anterior descending (LAD) lesion (32 cases),left circumflex ( LCF ) lesion (23 cases ) and right coronary artery(RCA) lesion (18 cases).And these two groups were also divided by lesion branch number into 1 lesion branch (23 cases),2 lesion branches (19 cases) and 3 lesion branches(31 cases).The time domain indexes of HRV were detected and calculated by 24 h dynamic blood pressutre and ECG,including standard deviation of normal number of R-R intervals (SDNN),standard deviation of per 5 min average normal R-R intervals(SDANNind),24 h average of standard deviation of per 5 min normal R-R intervals(SDNNind),root mean square of standard deviation of adjacent normal R-R intervals (rMSSD),and percentage of the difference of adjacent normal R-R intervals ＞ 50 ms (PNN50).And indexes of BPV were detected,including daytime systolic pressure standard deviation (dSSD),daytime diastolic pressure standard deviation (dDSD) and nighttime systolic blood pressure standard deviation (nSSD).The correlations between synchronic HRV and BPV and different coronary artery lesions were analyzed.ResultsSDNN,SDANNind significantly decreased and dSSD obviously increased with the aggravation of coronary stenosis,and there was statistical significance[ ( 115 ± 35 ) ms vs.(98 ± 25 ) ms vs.( 78 ± 28 ) ms,( 100 ± 30) ms vs.( 86 ± 23 ) ms vs.( 70 ± 29 )ms,(14 ± 3) mm Hg (1 mm Hg=0.133 kPa) vs.(20±4) mm Hg vs.(28±2) mm Hg](P＜0.05).rMSSD and PNN50 decreased,dDSD and nSSD increased with the aggravation of coronary artery stenosis,but there was no statistical significance (P＞0.05).SDNN and SDANNind in patients with LAD lesion and LCX lesion were significantly lower than those in control group,and dSSD was obviously higher than that in control group (P ＜ 0.01 or ＜ 0.05 ).SDANNind,rMSSD,PNN50,dDSD and nSSD in patients with LAD lesion and LCX lesion had no significant difference compared with those in control group (P ＞ 0.05 ).SDNN,SDANNind,SDNNind,rMSSD,PNN50,dSSD,dDSD and nSSD in patients with RCA lesion had no statistical significance compared with those in control group ( P ＞ 0.05 ).All the indexes of HRV tended to descend and indexes of BPV trended to raise with the increasing number of coronary artery lesion branches.But only the changes of SDNN,SDANNind,SDNNind,rMSSD,PNN50 and dSSD had statistical significance (P ＜ 0.05).Conclusions The more significantly HRV decreases and dSSD increases in patients with coronary artery disease,the more serious the coronary artery stenosis is and the wider the lesions are.The lesions are commonly located in LAD.It has certain guiding value for the evaluation of coronary artery diseases.

Objective: To explore postpartum MRI appearance and diagnostic value of MRI for placental implantation abnormality (PIA). Methods: Postpartum MRI findings of 11 PIA patients (mean age:28?4.5 years; range 23-25) were analyzed retrospectively. All patients underwent hysterectomy because their placentae were not discharged spontaneously, the postpartum hemorrhage added up to 800-4 500 ml and PIA was diagnosed by MRI 2-6 d after delivery. Results:Compared with the signal of the outer layer of the myometrium on the same scanning sequence, the placental signals appeared isointense or slightly hyperintense and the dividing line between the placenta and uterine wall was indistinct on T_1WI. On T_2WI the placental signal intensity was higher than that of the uterine wall. Placenta accreta showed that the placenta was confluent with the uterine wall and the junctional zone continued and the thickness of junctional zone was normal or slightly thinning. Placenta increta showed that the placental tissue invaded the myometrium in the shape of “triangle”, “nodule” or “mushroom”, and the junctional zone became thinner locally or discontinued. On Gadolinium-enhanced T_1WI, the intensity of placental enhancement was higher than that of uterine wall and the placental tissue was confluent with the uterine wall. The surgico-pathologic examination found 7 cases of placenta accrete and 4 cases of placenta increta. MRI diagnosis showed 8 cases of placenta accreta and 3 cases of placenta increta. There was one misdiagnosis by MRI. Conclusion: MRI is an ideal tool for postpartum diagnosis of PIA and can accurately evaluate placental configuration, the extent of placental accreta and the location and deepness of placental invasion.

AIM: To observe the effects of irbesartan and perindopril on pressure-overload cardiac hypertrophy in rats. METHODS: 40 male adult Sprague Dawley rats were divided into 5 groups. One was sham operation group, other four were aortic banding groups. One week after operation, all rats were gavaged with normal saline, perindopril, irbesartan or combination of perindopril and irbesartan. Morphometric determination, calcineurin (CaN) expression, CaN and sarcoplasmic reticulum (SR) Ca 2+-ATPase activity were performed at the end of 6 weeks of drug intervention. RESULTS: Left ventricular mass index (LVMI), transverse diameter of myocardical cell (TDM), CaN activity were remarkably decreased after drug intervention and this decrease was most remarkable in the combination group. SR Ca 2+-ATPase activity increased after drug intervention, especially in the combination group. CaN expression in myocardium were remarkably decreased after drug intervention. LVMI was positively correlated with TDM and CaN, negatively correlated with SR Ca 2+-ATPase. CONCLUSION: Both irbesartan and perindopril decrease CaN activity, increase SR Ca 2+-ATPase activity and combination of them has synergic effects on regressing of ventricular hypertrophy.

Objective To evaluate the clinical efficacy of long-pulsed 1064 nm Nd ∶ YAG laser combined with intralesional injection of triamcinolone in the treatment of keloids.Methods A total of 78 cases were randomly divided into two groups.The treatment group was treated with long-pulsed 1064 nm Nd ∶ YAG laser combined with intralesional injection of triamcinolone.The control group was only given intralesional injection of triamcinolone.The efficacy and adverse reactions were determined at the end of the first and the second course,respectively,and follow-up for one year was conducted in order to observe the recurrence.Results When the first course was over,cure rate of 21.95 ％ and efficiency rate of 73.17 ％ were observed in the treatment group,while they were 10.81％ and 45.95 ％,respectively,in the control group; the efficacy rate was statistically significant different in these two groups (P＜0.05).After two courses,cure rate of 70.73 ％ and efficiency rate of 100 ％ were observed in the treatment group while they were 45.95 ％ and 83.78 ％,respectively,in the control group,showing that both of the rates were statistically higher in the treatment group (P＜0.05).Conclusions Compared to intralesional injection of triamcinolone,long-pulsed 1064 nm Nd ∶ YAG laser combined with injection of triamcinolone has a more satisfactory effect on keloids.

ObjectiveTo investigate the effects of selective splenectomy on modulation of portal vein flow and prevention of small-for-size syndrome (SFSS) in living donor liver transplantation.MethodsTwenty six recipients who received LDLT from September 2007 to March 2008 were reviewed.The data of the portal vein flow of these recipients were collected during the operation.Simultaneous splenectomy was performed in patients with portal blood flow ＞250 ml/(min · 100g).No splenectomy was performed when the portal blood flow was less than 250 ml/(min · 100g).The effect of selective splenectomy on modulation of portal vein flow and whether splenectomy prevented the occurrence of SFSS were analyzed.ResultsThe portal vein flow decreased significantly after splenectomy in 8 patients who received splenectomy (P＜0.01),No SFSS occurred in the patients with or without splenectomy.Actual graft-to-recipient weight ratio (GRWR) of patients with splenectomy was significantly smaller than those with no splenectomy (P=0.044).The portal vein flow of patients with splenectomy was much higher than those with no splenectomy (P＜0.01).ConclusionAccording to the portal blood flow,selective splenectomy in LDLT decreased the portal vein flow and prevented the incidence of SFSS.

0.05), there were significant statistic differences of any other two TI values (P0.05), there were significant statistic differences of any other two TI values (P0.05 ) , there were significant statistic differences of any other two TI values (P

AIM: To investigate the effects of angiotensinⅡ receptor type Ⅰ antagonist irbesartan and angiotensin-converting enzyme inhibitor perindopril on the myocardial expression of connexin 43 (CX43), desmin and cardiac troponin T (cTnT) in the pressure overload-induced rat cardiac hypertrophy. METHODS: 40 male adult Sprague-Dawley rats were divided into 5 groups (8 animals for each): sham operation group and other four groups with ventricular hypertrophy caused by banding aortic artery. Drugs were given one week after operation as follows: sham operation group, normal saline (2 mL?kg~-1?d~-1 ig) was given; Operative groups: animals with ventricular hypertrophy were treated with normal saline 2 mL?kg~-1?d~-1 ig; Treatment groups: animals with ventricular hypertrophy were treated with perindopril 2 mg?kg~-1?d~-1 ig, irbesartan 20 mg?kg~-1?d~-1 ig or irbesartan 20 mg?kg~-1?d~-1 ig plus perindopril 2 mg?kg~-1?d~-1 ig, respectively. Left ventricular mass index (LVMI), transverse diameter of myocardial cell (TDM), and myocardial expression of CX43, desmin and cTnT by immunohistochemistry were performed at the end of 8 weeks of drug intervention. RESULTS: LVMI, TDM were remarkably decreased after drug intervention, compared to animals of operative group (P

ObjectiveTo explore the role of autofluorescence bronchoscopy in lung cancer operation and the meaning of choice lung cancer operation mode.MethodsTo retrospectively analyze 32 non-small cell lung cancer patients.Before lung cancer operation,white light bronchoscopy (WLB) and autofluorescence bronchoscopy (AFB) had been done routinely.Compared the different invasive tumor conditions by WLB and AFB,operation modes were decided by the edge of the tumor which were proved by biopsy pathology.ResultsIn 32 cases,19 cases underwent pulmonary lobectomy.One case underwent carinal resection and reconstruction.8 cases underwent sleeve lobectomy.4 cases underwent other therapy because of tumor airway metastasis.In 8 cases which underwent sleeve lobectomy,3 ca ses were found by WLB and AFB together,5 cases were found only by AFB.In 4 cases who had no operation chance,2 cases were found by WLB and AFB together,2 cases were only by AFB.The sensitivity for the detection of bronchial premalignant lesions was extremelyhigher withthe addition of AFB than WLBalone ( P ＜ 0.05 ).ConclusionAutofluorescence bronchoscopy is a safe and efficient technique which could improve the sensitivity of diagnosis in lung cancer than WLB.It is important to select operation mode.

Objective To investigate the effect of fatty liver graft on early poor prognosis in postoperative liver transplant adult patients.Methods The clinical data of 125 adult patients undergoing liver transplantation (LT) from fatty liver graft from January 2008 to October 2012 were retrospectively analyzed.Patients were divided into poor-prognosis group and non-poor-prognosis group.18 clinical factors were compared between these two groups by single factor and multiple factor Logistic regression analysis.Results Degree of steatosis (x2 =10.088,P =0.004),recipients' age (t =-3.917,P =0.002),pre-LTserum creatinine values (Z =-2.623,P =0.009),liver warm ischemia time (Z =-2.305,P =0.021),cold ischemia time (Z =-3.394,P =0.001) were identified to be statistically significant by the single factor analysis (P ＜ 0.05);By multivariate stepwise Logistic regression analysis on the above parameters,cold ischemia time (x2 =10.141,P =0.001,OR =1.003) and degree of steatosis (x2 =8.360,P =0.004,OR =4.619) were found as the independent risk factors,into the regression equation:Y =0.003 × cold ischemia time + 1.530 × degree of steatosis-4.243.Conclusions Donor liver cold ischemia time,degree of steatosis are independent risk factors for poor prognosis in early stage after liver transplantation.

With the establishment of reasonable selection criteria and continuous technical refinement, living donor liver transplantation (LDLT) has been widely performed in the world. Right-lobe LDLT has become the conventional procedure performed at many centers. In recent years, due to the considerations of donor safety, other graft types have become important choices for adult-adult LDLT, especially left-lobe LDLT, and good outcome has been achieved. Although the minimally invasive technique has certain technical and safety issues, it will play an important role in donor hepatectomy due to its unique advantages. At present, the research data for patients with hepatocellular carcinoma (HCC) are controversial, but LDLT can be applied in the treatment for these patients. The therapeutic regimens for LDLT should be selected on the basis of the individualized principle and comprehensive analysis of donor safety, surgical risk, and the recipient’s survival.