Objective To explore the clinical application of microsurgical techniques to therapy the femoral neck fracture in younger patients and prevent the necrosis of femoral head.Methods Seventy-four younger adults,age from 23 to 50,with femoral neck fractures were treated by open veducition,internal fixa- tion and pedicled bone transplantation from Jan.1995 to Dec.2004.All of the 74 patients were reviewed clin- ically and radiologically after an average of 3.2 years.Results In this group,19/74 cases(25.68%)had avaseular necrosis of the femoral head,which were diagnosised after an average of 28.5 months following inju- ry.Despite these results,these patients assessment with Harris system had been very good or good in 55/74 patients(74.32%).Conclusion It's an effective method to decrease the incidence of necrosis of femoral head after management the femoral neck fracture in younger patients by microsurgical techniques.

Adult ; Female ; Humans ; Middle Aged ; Thyroid Diseases ; microbiology ; Tuberculosis, Endocrine

Objective To compare the efficacy and safety of lidocaine and ropivacaine for scalp block in providing adequate analgesia with minimum side effects during awake craniotomy.Methods60 patients, ASA 1～2, were randomized into either lidocaine (L) group (n=30) or ropivacaine (R) group (n=30). 1% lidocaine or 0.5% ropivacaine were taken for scalp nerve block 15 min before incision. Supplemental oxygen was given using nasal prongs that were adapted for the monitoring of end tidal CO2 and respiratory rate. Serial parameters about circulation and respiratory were measured and drug consumption were recorded.ResultsThe hemodynamic parameters of L group were higher than R group in the latter stage(P<0.05). L group was associated with significantly more consumption of sufentanil and more respiratory depression than R group(P<0.05).ConclusionRopivacaine, taking for scalp block undergoing awake craniotomy, is associated with less consumption of analgesic and less respiratory depression than lidocaine.

ObjectiveTo study electrophysiological characteristics and catheter ablation left-sided accessory pathways of Mahaim fiber.MethodsTwenty-eight patients underwent catheter ablation for Mabaim fiber and 3 patients was left-sided accessory pathways.All of them were male with 34,20,38 years old.The tachycardia history was1-5years. Electrophysiological characteristics,target sitesand electrocardiogram(ECG,12 leads) were recorded through catheter from coronary sinus(CS),high right atrium(HRA),His bundle and ablation.ResultsOne patient's ECG showed little preexcitation,the other two were normal. Atrial stimulation could be easily induced tachycardia.Their ECG showed wide QRS waves (right bundle branch block or similar right bundle branch block).The characteristics of accessory pathways were slow and anterograde decremental conduction as well as blocked by adenosine triphosphate injection.Ventricular-atrial conduction was via atrioventricular node with centripetal decreasing transmission during ventricular pacing.During tachycardia,the His bundle electrogram resulted in a V-H-A pattern,the retrograde A in His bundle was pioneer.The atriofascicular pathways of 2 patients were completely ablated respectively in left posterior lateral and before the free wall of mitral valve ring.The nodoventricular pathway of 1 patient was successfully ablated in left middle posterior lateral of mitral valve ring.ConclusionsThe left-sided accessory pathways of Mahaim fiber is an uncommon accessory pathway,which has specific electrophysiological characteristics.It is effective and safe to ablate accessory pathway with radiofrequency.

Atrial Fibrillation ; surgery ; Catheter Ablation ; methods ; Humans ; Male ; Middle Aged ; Recurrence ; Tachycardia, Reciprocating ; etiology ; surgery

Objective To investigate the electrophysiological characteristics of atrial tachycardia (AT) originating from the side of the bundle of His, and to analyze the efficacy and safety of transcatheter radiofrequency ablation via the right side of the bundle of His and left noncoronary sinus of aorta for the treatment of AT. Methods A total of 12 patients with AT originating from the side the bundle of His, which was confirmed by conventional electrophysiological study and atrial activation patterns, were included in this study. The patient’s age ranged from 12 to 64 years old with a mean of (47.4±14.6) years. The mapping was carried out at the right side of the bundle of His and radiofrequency ablation was performed. When the ablation procedure failed, or the junction zone rhythm or atrioventricular block occurred, ablation via the left noncoronary sinus of aorta was employed. Results Atrial stimulation could repeatedly induce and terminate AT in all the 12 patients, the average cycle length was (327±76) ms. TA was terminated within 10 seconds after the start of ablation in 10 patients during their AT attacks. Ablation was unsuccessful in 2 patients. Ablation via the right side of His bundle was successfully accomplished in 2 patients, and the ablation via the left noncoronary sinus of aorta was successfully carried out in 8 patients. The average follow-up time was 1-6 years, and no recurrence of AT was observed. Conclusion Atrial tachycardia originating from the side of the bundle of His has certain electrophysiological characteristics, and transcatheter radiofrequency ablation is safe and effective for its treatment. Ablation via the left noncoronary sinus of aorta should be considered as a strategy of priority.

Objective: To explore the feasibility with the safety at peri-operative and early post-operative periods for left atrial appendage occlusion in patients with non-valvular atrial ifbrillation (AF).
Methods: A total of 17 non-valvular AF patients with transesophageal echocardiography (TEE) and CAHDS2 evaluation who received left atrial appendage occlusion in our hospital were summarized. The effect and complications during peri-operative and 1 month post-operative periods were analyzed.
Results: All 17 patients had successful operation without severe complications. There were 8 patients having small amount residual shunt by TEE examination, 2 having ecchymosis near the puncture point at peri-operative period and 3 having small amount of hydropericardium by peri-cardio ultrasound examination. At the average of 45 days follow-up study, only 3 patients had small amount residual shunt, no left atrium thrombus and hydropericardium were observed.
Conclusion: Left atrial appendage occlusion has the high success rate, it is safe during peri-operative and early post-operative periods in non-valvular AF patients.

AIMIn order to study the effects of pituitary adenylate cyclase activating polypeptide(PACAP) on brain edema induced by ischemia in rats and its underlying receptor mechanism.

METHODSBrain ischemia model in rats was established by ligaturing four--vessels. The percentage ratio of wet over dry tissue weight, sodium and potassium contents of dry brain tissue were measured by weighing and enzymatic analysis methods.

RESULTSThe brain water contents significantly increased after rats exposed to 1 h of reperfusion following 30 - minute ischemia. Furthermore, sodium contents in brain tissue increased and potassium contents decreased following perfusion. Changes of brain water contents, sodium and potassium contents were relieved by lateral ventricular injection of PACAP in the concentration of 1 x 10(-9), 1 x 10(-10) or 1 x 10(-11) mol respectively before ischemia. The effect of PACAP could be blocked by MCAP6 - 38 (specific type I PACAP receptor antagonist) lateral ventricular injection prior to PACAP administration.

CONCLUSIONExogenous PACAP may act as a protective effect in brain edema induced by ischemia in rats, which is mediated by type I receptor.

Animals ; Brain ; metabolism ; physiopathology ; Brain Edema ; etiology ; metabolism ; prevention & control ; Brain Ischemia ; complications ; metabolism ; Male ; Neuropeptides ; metabolism ; Pituitary Adenylate Cyclase-Activating Polypeptide ; pharmacology ; Potassium ; metabolism ; Rats ; Rats, Sprague-Dawley ; Sodium ; metabolism

Nicotinamide adenine dinucleotide phosphate oxidases (NOXs) are the major enzymatic source of reactive oxygen species (ROS). NOX2 and NOX4 are expressed in the heart but its role in hypoxia-induced atrial natriuretic peptide (ANP) secretion is unclear. This study investigated the effect of NOX on ANP secretion induced by hypoxia in isolated beating rat atria. The results showed that hypoxia significantly upregulated NOX4 but not NOX2 expression, which was completely abolished by endothelin-1 (ET-1) type A and B receptor antagonists BQ123 (0.3 µM) and BQ788 (0.3 µM). ET-1-upregulated NOX4 expression was also blocked by antagonists of secreted phospholipase A2 (sPLA2; varespladib, 5.0 µM) and cytosolic PLA2 (cPLA2; CAY10650, 120.0 nM), and ET-1-induced cPLA2 expression was inhibited by varespladib under normoxia. Moreover, hypoxia-increased ANP secretion was evidently attenuated by the NOX4 antagonist GLX351322 (35.0 µM) and inhibitor of ROS N-Acetyl-D-cysteine (NAC, 15.0 mM), and hypoxia-increased production of ROS was blocked by GLX351322. In addition, hypoxia markedly upregulated Src expression, which was blocked by ET receptors, NOX4, and ROS antagonists. ET-1-increased Src expression was also inhibited by NAC under normoxia. Furthermore, hypoxiaactivated extracellular signal-regulated kinase 1/2 (ERK1/2) and protein kinase B (Akt) were completely abolished by Src inhibitor 1 (1.0 µM), and hypoxia-increased GATA4 was inhibited by the ERK1/2 and Akt antagonists PD98059 (10.0 µM) and LY294002 (10.0 µM), respectively. However, hypoxia-induced ANP secretion was substantially inhibited by Src inhibitor. These results indicate that NOX4/Src modulated by ET-1 regulates ANP secretion by activating ERK1/2 and Akt/GATA4 signaling in isolated beating rat hypoxic atria.

Nicotinamide adenine dinucleotide phosphate oxidases (NOXs) are the major enzymatic source of reactive oxygen species (ROS). NOX2 and NOX4 are expressed in the heart but its role in hypoxia-induced atrial natriuretic peptide (ANP) secretion is unclear. This study investigated the effect of NOX on ANP secretion induced by hypoxia in isolated beating rat atria. The results showed that hypoxia significantly upregulated NOX4 but not NOX2 expression, which was completely abolished by endothelin-1 (ET-1) type A and B receptor antagonists BQ123 (0.3 µM) and BQ788 (0.3 µM). ET-1-upregulated NOX4 expression was also blocked by antagonists of secreted phospholipase A2 (sPLA2; varespladib, 5.0 µM) and cytosolic PLA2 (cPLA2; CAY10650, 120.0 nM), and ET-1-induced cPLA2 expression was inhibited by varespladib under normoxia. Moreover, hypoxia-increased ANP secretion was evidently attenuated by the NOX4 antagonist GLX351322 (35.0 µM) and inhibitor of ROS N-Acetyl-D-cysteine (NAC, 15.0 mM), and hypoxia-increased production of ROS was blocked by GLX351322. In addition, hypoxia markedly upregulated Src expression, which was blocked by ET receptors, NOX4, and ROS antagonists. ET-1-increased Src expression was also inhibited by NAC under normoxia. Furthermore, hypoxiaactivated extracellular signal-regulated kinase 1/2 (ERK1/2) and protein kinase B (Akt) were completely abolished by Src inhibitor 1 (1.0 µM), and hypoxia-increased GATA4 was inhibited by the ERK1/2 and Akt antagonists PD98059 (10.0 µM) and LY294002 (10.0 µM), respectively. However, hypoxia-induced ANP secretion was substantially inhibited by Src inhibitor. These results indicate that NOX4/Src modulated by ET-1 regulates ANP secretion by activating ERK1/2 and Akt/GATA4 signaling in isolated beating rat hypoxic atria.