Objective To explore the treatment perscription with the method of integrated traditional and western medicine in type 2 diabetes.Methods With the methods of differential diagnosis of diseases in western medicine and differential symptoms and signs in traditional Chinese medicine(TCM),the diseases were separated into different patterns of syndrome and treated with propotional prescription of TCM.The curative effect was evaluated with the scores in the integration of symptoms and the changes on the levels of blood glucose and glycated-hemoglobin.Results Clinical curative effects were achieved using the prescription of TCM and the simple western medicines.The curative effects were much better on lowering integration of symptoms and the level of pre-meal blood glucose with the prescription of TCM than those of the simple western medicine.Conclusion The clinical curative effects are significant on relieving the clinical symptoms of patients with the prescription of TCM than those of the simple western medicine.

Objective　To identify the regression of left ventricle after aortic valve replacement for aortic regurgitation complicated by extremely dilated left ventricle. Methods　34 cases were reviewed to evaluate the regression of left ventricle by UCG. Results　All patients survived after aortic valve replacement. The left ventricular end diastolic diameter (LVEDD) decreased dramatically 1－2 weeks and further decreased 6－12 months after operation, i.e. 87.2±6.6 mm (preoperation), 70.2±13.5 mm (1－2 weeks post-operation), and 62.0±12.52 mm (6－12 months post-operation), respectively, P<0.01. If the patients were grouped according to left ventricular ejection fraction (LVEF) before operation: group A(LVEF<50%) and group B (LVEF>50%), reduction of LVEDD and increase of LVEF in group B were more significant than in group A. Conclusion　LVEF is the key factor for the regression of left ventricle and can be used to predict the prognosis.

Objective To construct a short hairpin RNA (shRNA) adenovirus vector targeting Aktl (protein kinase B1, PKBI/Aktl) and cyclooxygenase-2 (COX-2) and study its effects on the invasion and metastasis of SGC-7901 human gastric adenocarcinoma cells. Methods Aktl and COX-2 shRNA expression frames were subcloned to pGSadeno adenovirus vector by homologous recombination technology to construct pGSadeno-Aktl+COX-2 (rAdS-A+C) vector. After screening and amplification, the recombinant adenovirus vector was digested with PacI and transfected into SGC-7901 cells, the titer and transfection efficiency were detected by fluorescent microscopy. Aktl and COX-2 mRNA and protein expression was identified by real-time PCR and Western blot. MMP-2 and MMP-9 contents in control group SGC-7901、rAd5-HK and treatment group rAdS-A+C were detected by ELISA assay and transwell assay analyzed cell invasion and metastasis ability. Results Adenovirus vector rAdS-A+C was successfully constructed and it dramatically down-regulated Aktl and COX-2 mRNA and protein expression in SGC-7901 gastric cancer cells. MMP-2 and MMP-9 contents in treatment group rAd5-A+C were respectively (39.7± 1.7) ng/ml, (31.3±3.6) ng/ml, and they were lower than those in control group SGC-7901 (278.4± 15.5) ng/ml, (225.4±15.1) ng/ml and rAd5-HK (275.5±2.1) ng/ml, (226.0±23.3) ng/ml (P= 0.01, P=0.021). Transwell assay showed treatment group rAd5-A+C significantly inhibited the invasion and metastasis of SGC-7901 gastric adenocacinoma cells. Conclusions Adenovirus-mediated targeting Aktl and COX-2 shRNA can inhibit the invasion and metastasis of SGC-7901 human gastric adenocarcinoma cells.

Objective To construct a short hairpin RNA (shRNA) adenovirus vector targeting P85 and protein kinase B1 (PKB1/Akt1) and study its effects on the growth of SGC-7901 human gastric adenocareinoma cells. Methods P85 and Aktl shRNA expression frames were subcloned to pGSadeno adenovirus vector with homologous recombination technology to construct pGSadeno-P85 + Akt1 (rAd5-P + A) vector. After screening and amplification, the recombinant adenovirus vector was digested with PacI and transfected into SGC-7901 cells and then its titer and transfection efficiency were detected with fluorescent microscope. P85 and Akt1 mRNA protein expression was identified with real-time PCR and Western blot. The proliferative activity of tumor cells was evaluated with MTr assay and flow cytometry in vitro, rAd5-HK and rAd5-P + A mediated by adenovirus were injected into the established subcutancous SGC-7901 gastric adenocarcinoma in nude mice. During the observation period of 21 days, tumor volume was measured every 3 days to further testify the anti-tumor effect of rAd5-P + A on the SGC-7901 gastric adenocarcinoma cells and cell in situ apoptosis was detected with TUNEL assay. Results The adenovirus vector rAd5-P + A was successfully constructed and it dramatically downregulated P85 and Akt1 mRNA expression in SGC-7901 gastric adenocarcinoma cells. Compared with a control group of SGC-7901 cells and cells transfected with general adenovirus rAd5-HK as control, P85 and Akt1 protein expression 48 h and 72 h after rAd5-P + A transfection was decreased by 57.5% and 63. 7%, 67. 8% and 75.6% with statistical significance(P = 0. 005, P = 0. 003). Cell proliferative activity in rAd5-P + A transfected cells was suppressed from the second day (P <0. 001) and the decreased P85 and Akt1 expression was accompanied by 5.9% -7. 1% decrease of S phase fraction and 12. 1% - 13.7% increase of G0/G1 phase. The tumor volume of rAd5-P + A treated group was smaller than that of the control and rAd.5-HK group with statistical significance (F = 9. 871, P = 0. 025) . Moreover, rAd5-P + A could induce cell in situ apoptosis. Conclusions Adenovirus-mediated targeting P85 and Akt1 shRNA can inhibit the growth of SGC-7901 human gastric adenocarcinoma cells and this may provide a new strategy of combination gene therapy in gastric adenocarcinoma.

Objective To study the chemical components from Dryopteris fragrans and their biological activities.Methods By means of HPLC and other column chromatography,the chemical components were isolated from D.fragrans and their chemical structures were identified by spectral and chemical tests in accordance with their physicochemical characteristics.Furthermore,the cytotoxicity of the chemical components for Bel-7402,HCT-8,and A-549 cells was measured by MTT method.Results Four compounds,geniposide(Ⅰ),3S,5R,6R,7E,9S-megastigman-7-ene-3,5,6,9-tetrol-3-O-?-D-glucopyranoside(Ⅱ),(6S,9R)-3-oxo-?-ionol-9-O-?-D-glucopyranoside(Ⅲ),and fragranoside a(Ⅳ) were iso-lated and identified.Conclusion Compound Ⅳ is a new compound.And all the other three compounds Ⅰ-Ⅲ are found in plants of Dryopteris Adanson for the first time.The results of pharmacological experiments indicate that compounds Ⅰ and Ⅲ show strong cytotoxicity.

ObjectiveTo investigate methods of early postoperative rehabilitation and its effects on patients with bicondylar tibial plateau fracture treated by modified dual plating.Methods66 patients with bicondylar tibial plateau fracture from Tianjin Hospital were divided into 2 groups according to the starting time for postoperative rehabilitation: early rehabilitation group (n=30), convalescents rehabilitation group (n=36). The two groups had the same treatment since the fourth week postoperative. Tibial plateau angle (TPA) and posterior slope angle (PA) of tibial plateau were measured to evaluate the stability of proximal tibial and knee alignment. The Hospital for Special Surgery (HSS) score system and knee joint range of motion (ROM) were used as the parameters for knee function.ResultsThe mean value of TPA and PA had no significant changes, compared to the final follow-up and postoperative X-ray films(P>0.05); the differences between the two groups were statistically significant in the mean HSS score and mean value of knee flexion and extention ROM(P<0.01 or 0.05). There was significantly positive correlation between starting time and the total number of treatment was significant(P<0.01), while negative correlation with flexion ROM of knee joint and the HSS score(P<0.01).ConclusionThe correlation between rehabilitation intervention timing and functional recovery for patients with bicondylar tibial plateau fracture treated by modified dual plating is significant, early individual and systematic rehabilitation therapy can effectively improve the prognosis features of patients.

Objective To summarize the key points of nursing care in reservation of catheters in 11 cases of nasopharyngeal carcinoma patients who received concurrent chemo-radiotherapy with symptomatic thrombosis after ultrasound-guided implantation of double-lumen PICCs(PowerPICC).Methods From January,2014 to December,2015,totally 11 cases with symptomatic venous thromboembolism were identified among 109 cases of nasopharyngeal carcinoma patients receiving concurrent radiotherapy and chemotherapy,and observation and nursing care were provided at the early stage of thrombosis and during thrombosis.Results All double-lumen PICCs were reserved,and no recurrence or aggravation of thrombosis was recorded to the end of the treatment.The duration of carrying PICCs was 67～89(77.45±6.65) days.Conclusion With careful treatment and nursing,PICC catheter-related complications can be reduced and the duration of carrying catheters can be prolonged,which leads to accomplishment of the treatment plan for patients.

OBJECTIVETo identify the clinical predictors of atrial fibrillation (AF) after coronary artery bypass grafting (CABG).

METHODS322 consecutive patients who had undergone isolated CABG were reviewed. Preoperative, intraoperative and postoperative data were collected. Patients were grouped according to whether AF appeared postoperatively.

RESULTSAF occurred in 75 patients (23.3%). Most cases of AF (85.6%) appeared on or before the third postoperative day. The mean age for patients with AF was 62.5 years compared with 56.7 years for patients without AF (P < 0.05). The mean aortic crossclamp time for patients with AF was 67 min compared with 60.3 min for patients without AF (P < 0.05). The mean duration of cardiopulmonary bypass for patients with AF was 109.6 min compared with 97.3 min for patients without AF (P < 0.05). The mean duration of mechanical ventilation for patients with AF was 19.1 h compared with 15.7 h for patients without AF (P < 0.05). Multivariate logistic regression analysis was used to identify the following independent predictors of postoperative AF (P < 0.05): age > or = 65 years (OR 2.7; 95% CI 1.5 to 5.1), lesions in the right coronary artery (OR 2.5; 95% CI 1.4 to 4.5), and early postoperative withdrawal of beta blocker (OR 3.9; 95% CI 2.1 to 7.7).

CONCLUSIONSAF remains the most common complication after CABG. Age and lesions in the right coronary artery can influence the incidence of AF, and beta blocker and magnesium may be the most economical and effective prevention for AF early after CABG.

Adult ; Age Factors ; Aged ; Atrial Fibrillation ; diagnosis ; etiology ; Coronary Artery Bypass ; adverse effects ; Coronary Vessels ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications ; Prognosis

Abstract:Objective To evaluate the outcome of surgical treatment for congenital coronary artery fistulas (CAF) in 52 patients seen between May 1988 and July 1999.Methods Fifty-two patients ranging in age from 9 months to 58 years (mean 15.7±16.4 years) were studied. Thirty-six patients had no other cardiac defects, 9 of those patients were more than 20 years old and presented with symptoms. Only one of 36 patients less than 20 years old had clinical findings before surgery. Sixteen patients had associated cardiac lesions. The site of fistula origin was the right coronary artery in 37 patients (71.2%), and the left coronary artery in 15 patients (28.8%). The sites of CAF drainage were the right ventricle, right atrium, left ventricle, left atrium and pulmonary artery in 22 (42.3%), 16 (30.8%), 6 (11.5%), 3 (5.8%), and 5 (9.6%) patients, respectively. The mean diameter of the fistula in 43 patients with single ostium was 7.34±4.12?mm.Results Cardiopulmonary bypass was used in all patients and no patient died. An arteriotomy was made on the anomalous coronary artery and the proximal opening of a fistula was closed within the vessel in 10 patients. Closure of the distal opening of a fistula draining into a cardiac chamber or pulmonary artery was performed in 26 patients. In 16 patients, both the proximal and distal opening were closed. Two and 3 distal opening of a fistula were found in 6 and 3 patients, respectively. No residual shunt was found before patients were discharged from the hospital. Forty patients were followed up for a mean period of 3.14±1.84 years. The remaining 12 patients could not be contacted during follow-up. No clinical symptoms were found in those patients during follow-up but one patient still presented with ST-T change. Conclusion Early and properly surgical management is safe and effective for congenital coronary fistula.

Objective To report our operative experience with aortic root replacement in 231 patients with aortic root aneurysm and discuss the current indications,methods,and surgical techniques.Methods Between January 1994 and August 1999,a group of 231 consecutive patients underwent aortic root replacement at our hospital,with 13 being treated on an emergency basis.There were 189 men and 42 women,ranging in age from 14 to 69 years.The diameter of the aneurysm varied from 4.5 to 11 cm.Among this group,145 had isolated aortic root aneurysms,65 suffered from DeBakey type Ⅰ aortic dissection,and the remaining 21 were diagnosed as having DeBakey type Ⅱ aortic dissection.Aortic valve regurgitation occurred in all cases.Aortic root replacement was performed with composite valved graft in 229 patients,and in 2 patients the aortic valve was preserved.Results The hospital mortality rate was 3.03%(7 patients).Early complications included re-exploration for bleeding in 6 patients,pericardial effusion in 9,as well as cerebral infarction,pleural effusion,and pneumothorax in 2 patients each.One hundred and seventy-five patients(78.12%)were followed up,with a mean follow-up time of 15.7 ± 13.1 months(range,2 weeks to 65 months).One patient died from lower-limb embolism and renal dysfunction 3 months postoperatively.Three patients died from postoperative anticoagulation accidents.The preoperative and postoperative mean left ventricular end-diastolic diameters were significantly different(68.1 ± 9.4 mm,range 54 to 112 mm;vs 54.8 ± 8.2 mm,range 38 to 88 mm;P＜0.001).Conclusions Once a diagnosis of acute aortic root dissecting aneurysm is made,the patient should undergo surgery as soon as possible if the general conditions permit.Aortic aneurysm without dissection or with chronic dissection should be operated if the diameter of the aneurysm is greater than 5 cm.