Objective To assess the efficacy and safety of co-administration of aspirin and low-dose clopidogrel in patients undergoing percutaneous coronary intervention (PCI) after 1 year.Methods From March 2004 to September 2010,a total of 3366 patients with successful drug-eluting stents implantation after 1 year were divided into group A (aspirin combined with low-dose clopidogrel,n=1682) and group B (aspirin alone,n=1684).The average follow-up period was (29.5±16.3) months (19 months-76 months).The major adverse cardiovascular and cerebrovascular events and clinical complications were evaluated.Results Rates of cardiovascular death were 0.1 ％(2 cases) in combination group and 0.9％ (15 cases) in aspirin group,the risk ratio (HR) was 0.154 [(95％ CI:0.035 0.675),P＜0.05].Myocardial infarction occurred in 9 patients (0.5％) in group A and 27 patients (1.6％) in group B,the risk ratio (HR) was 0.036 [(95％ CI:0.153-0.741),P＜0.01].Rates of stroke were 0.4％ (7 cases) in group A and 1.6％ (27 cases) in group B,the risk ratio (HR) was 0.301 [(95％ CI:0.131 0.693),P ＜ 0.01].Recurrent ischemia with rehospitalization occurred in 152 patients (9.0％) in group A and 274 patients (16.3％) in group B,the risk ratio (HR) was0.601 [(95％ CI:0.491-0.735),P＜0.01].The cumulative survival rate in patients died of cardiac causes was significantly better in group A than in group B (P＜0.01).The cumulative incidence of major adverse cardiovascular and cerebrovascular events was significantly lower in group A than in group B (P＜0.01).There were no significant differences in total number of deaths,target vessel revascularization,stent thrombosis,incidences of severe bleeding,mild bleeding,leukopenia and thrombocytopenia between the two groups (all P＞0.05).Conclusions In patients with PCI after 1 year,the co-administration of aspirin and low-dose clopidogrel reduces the risks of major adverse cardiovascular and cerebrovascular events,and does not increase the risks of bleeding and cytopenia.

Objective:To investigate the clinical significance of E-Cadherin (E-CD) expression in breast carcinoma.Methods:The expression of E-CD gene in human breast carcinomas was studied by immunohistochemistry(SABC) in 92 patients and the relationship between the expression and the clinical pathologic parameters was observed.Results:The positive rate of E-CD expression was 48.9%(45/92).The group with negative E-CD expression has higher incidence of distant metastasis (34%,16/47)than the positive one (15.6%,7/45)(P

Objective To evaluate the special roles of modified procedure of instrumented posterior lumbar interbody fusion (PLIF) for the treatment of the isthmic lumbar spondylolisthesis. Methods Surgical procedure was modified. The definitive reduction of the spondylolisthesis using pedicle screw instrumentation was followed by primary reduction using intervertebral disc space distraction and interbody fusion with insert cages and local morselized bone after decompressive laminectomy. A prospective, single-cohort, observational study of the clinical outcomes and radiological data, was assessed in a series of 46 patients with isthmic spondylolisthesis who underwent surgery from January 1999 to February 2004. The clinical outcomes were evaluated according to Oswestry disability questionnaire, and the radiographic data included slipping degree, slipping angle and posterior height of intervertebral disc. Thin-section helical computed tomography (CT) scanning was used in 5 cases post-operatively to assess the interbody fusion. Results Post-operatively, the slipping degree reduced, the posterior heights of intervertebral space increased and slipping angle decreased. The radiographic data had no obvious loss in mean follow-up time of 36 months (range, 12-73 months). Thin-section helical CT study clearly demonstrated the radiographic presence or absence of bridging bone, and solid bony fusion could be obtained at least one year after operation. The objective clinical outcomes of the Oswestry disability questionnaire were in average 33.6?6.4 before operation and 17.6?5.5 after operation. Conclusion The modified procedure as described offers advantages for isthmic spondylolisthesis, not only in substantial deformity correction, but also in suitable interbody cages choosen and normal sagital plane alignment restoration.

OBJECTIVE:To establish a method for the determination of4major caffeine metabolites and to discuss the significance of which in the evaluation of the activity of drug-metabolizing enzyme CYP1A2.METHODS:The caffeine metabolites in the urine like5-acetylamino-6-formamido-3-methyluric acid(AFMU),1-methyluric acid(1U),1-methylxanthine(1X)and1,7-dimethyluricacid(17U)were determined by RP-HPLC gradient elution method,the ratios of metabolins(AFMU+1X+1U)/17U was calculated,the frequency distribution histogram was drawn and the activity of CYP1A2was evaluated.RESULTS:The mean value of the ratio of the metabolins in the subjects was4.27,which was in normal distribution.CONCLUSION:The method is simple,accurate and rapid,which is suitable for the determination of caffeine metabolites in urine and the study of the activities of CYP1A2.

Objective To evaluate toxicity and safety of trans-resveratrol (t-RSV). Methods For assays of acute toxicity,genetic toxicity, and sub-chronic toxicity, Ames test, mice bone marrow erythrocyte micronucleus, and mice sperm abnormality were performed. Results In the acute oral toxicity tests, maximum tolerable dose (15 g/kg) in male and female Kunming mice showed no toxicological signs. For 90-d feeding of t-RSV at dosage range of 167-500 mg/(kg·d) in both male and female Sprague-Dawley rats, no noticeable toxicological effects were observed.Conclusion T-RSV has no acute toxicity and no genotoxicity, no harmful effects on the human body at the tested dosage range and thus resveratrol is safe for human consumption.

We reported a clinical caseof gas gangrene in the lower back and buttocks due to local intramuscular injection. A 43-year-old male was treated by local private clinic for low back pain. He underwent local intramuscular injection in his lower back and buttocks. 5 or 6 hours after the treatment,he felt worsen of low back pain (VAS 5 points)with a fever. After one day of treatment, the lower back pain was even worse(VAS 8 points). And he had soy-sauce urine and a high fever. The results of laboratory examination and clinical manifestation suggested multiple organ failure within a short period of time. Imaging (CT) suggested large area of gas and muscle necrosis in the lower back and buttocks. Considering the progress of the disease, emergency surgery on lumbar back and right buttocks was performed after hospitalization. Rapid bacterial smear reported gram-positive coarse bacteria. Anaerobic culture suggested clostridium perfringens. Aerobic culture result did not show any bacterial growth. According to the clinical manifestation, imaging (CT), intraoperative judgment and postoperative anaerobic culture results, the clinical diagnosis was gas gangrene. Gas gangrene is a special infectious disease in clinic, which can be characterized by low morbidity, difficult early diagnosis,rapid disease progression and high mortality. Sinceintramuscular injection leaded to this disease in our case, the importance of standardized aseptic procedures should be emphasized.

BACKGROUND: Stem cell regeneration can repair injured myocardium. However, bone marrow mononuclear cells (BM-MNCs) transplantation for non-ischemic heart failure remains poorly understood.OBJECTIVE: To investigate effect of transplantation of autologous BM-MNCs on cardiac function in canine model of heart failure by rapid ventricular pacing. METHODS: Implantation and model control groups were subjected to model establishment of heart failure by rapid pacing of apex of right ventricle, and respectively injected with CM-DiI-labeled BM-MNCs and normal saline into myocardium. After 4 weeks, all dogs were sacrificed, and specimens of myocardium were collected from the apex, anterior wall and interventricular septum. All specimens were labeled by FITC. Myocardial fibrosis conditions of implanted cells were observed, collagen volume fraction was determined, and hemodynamic indexes were measured. RESULTS AND CONCLUSION: BM-MNCs labeled by CM-DiI and FITC were observed in the transplantation group showing yellow fluorescence, while in the control group FITC-labeled green fluorescence was seen. HE and Masson staining showed that inflammatory cell infiltration in interstitial matrix, displaying interstitial fibrosis and myocardial fibrosis in model control group, but no obvious inflammatory cell infiltration or myocardial fibrosis was observed in the transplantation group, indicating a success model establishment of heart failure by rapid ventricular pacing. Compared with model control group, the collagen volume fraction decreased significantly (P < 0.05), ejection fracture remarkably increased (P < 0.05), but left ventricular end-diastolic and end-systolic diameter remained unchanged in the transplantation group (P > 0.05). Autologous BM-MNCs in canine model of heart failure show myocardium-like cells differentiation, and improve heart function, which possibly associate with the ability of inhibiting the myocardial fibrosis.

Objective　The aim of this study was to approach the effects of percutaneous transluminal coronary angioplasty (PTCA) and stenting on QT dispersion (QTd) in patients with coronary heart disease. Methods　PTCA and stenting were performed successfully on 42 patients with coronary heart disease. QTd and corrected QTd (QTcd) were obtained with a standard 12-lead ECG before and after PTCA+ Stent. Results　QTd and QTcd after PTCA+Stent were reduced significantly compared to those before PTCA+Stent (P<0.01). There were no significant difference in QTd and QTcd before PTCA+Stent between single vessel lesion and multi-vessel lesion, but after PTCA+Stent, QTd and QTcd in single vessel lesion were decreased significantly compared to those in multi-vessel lesion. The ventricular arrhythmia in 9 patients was over after PTCA+Stent. Conclusions　QTd and QTcd were decreased significantly after PTCA+Stent because of the improvement of myocardial ischemia and heterogeneous repolarization in patients with coronary heart disease. The degree in decreasing QTd and QTcd was associated with compensatory circulation in coronary artery.

Objective To discuss the surgical therapy of primary leiomyosarcoma of the inferior vena cava(PIVCLS).Methods Retrospective analysis of was made 5 patients of PIVCLS from Oct 2009 to May 2011 hospitalized in Department of Vascular Surgery,Provincial Hospital Affiliated to Shandong University.All patients underwent surgical resection,combined with reconstruction of bilateral renal vein and distal inferior vena cava using artificial vascular graft.Results Surgical resection was performed successfully in all patients.The mean operation time was 166.6 min,with mean blood loss 1 560 mL.Leiomyosarcoma intruding the inferior vena cava and right renal vein were observed in all patients during operation.The mean size was 12 cm × 10 cm× 8 cm.The diagnosis of PIVCLS in 5 patients was confirmed by postoperative pathologic examination.All patients did not present lower extremity swelling after surgery and discharged from hospital with normal blood (BUN) and (CREA).All patients were administrated with oral warfarin therapy after discharge.No clinical relapse and pulmonary embolism was observed during the follow-up (range 3 months to 12 months).The ultrasound revealed the patency of artificial vascular grafts in all patients.Conclusions Surgical resection combined with reconstruction of bilateral renal vein and distal inferior vena cava using artificial vascular graft is an effective and feasible treatment of PIVCLS.Leiomyosarcoma is completely eliminated and important abdominal viscera are protected well during the procedure because of minimal impact on hemodynamics.The incidence of postoperative pulmonary embolism also decreases obviously.

Objective To ev aluate clinical results of selective anterior corpectomy combined with segmental discectomv and fusion for multilevel cervical myelopathv andits related factors.Methods Twenty-five patients of multilevel cervical myelopathv with 3 or 4 consecutive segments were treated with selective anterior corpectomy combinedwith segmental discectomy and fusion.The clinical results were evaluated by the parameters including improvement of Japanese Orthopaedic Association (JOA)score postoperatively,fusion rate,and the degree of spinal canal decompression and range of motion of the cervical spine.Results JOA score were improved from 9.5±1.3 pre-operatively to 13.8±0.8(P＜0.01)6 months post operation and 1 3.6±0.9(P＜0.05)atthe final follow-up.Bony fusion was verified by X-ray and 3D-CT scan 1 2 months post operation and final follow-up.Moreover,the degree of decompression of the spinal canal was also remarkable.The range of motion of the cervical spine after operation decreased significantly(P＜0.05).Conclusion Selective anterior corpectomy combined with segmental discectomy and fusion was an alternative choice for the surgical treatment of multilevel cervical myelopathy.