Objective:In vitro fertilization and embryo transplantation in patients with endometrial implantation window phase of natural killer cell ( uNK ) influence on the endometrial microvascular and uterine artery pulsatility index and embryo implantation.Methods:A retrospective analysis of our hospital from January 2009 to July 2013 the implementation of in vitro fertilization and embryo transfer(IVF-ET) clinical data of 37 patients,according to whether the success of pregnancy and at least 2 times for IVF-ET failure into success group(26 cases)and the failure group(11 cases),compared two groups of research object during the window of implantation in the uterus endometrial uNK cell marker CD56+, uterine artery pulsatility index, vascular endothelial marker F8 factor,alpha smooth muscle actin( alpha SMA) and myosin heavy chain( SMM) and the relationship between the expression of difference.Results:Success group based FSH 3.52±0.68(mU/ml),basal antral follicles of 9.44±2.53 compared with the failure group differences were not statistically significant(P>0.05).The successful group of uNK cells of 27.18±5.94(%),MVD 6.79±1.74 (%) ,αSMA 33.72 ±4.19 (%) , SMM 25.19 ±5.83 (%) were significantly higher than the expression rate of IVF-ET assisted reproductive failure group(P<0.05).The number of uNK cells,the proportion of endometrium during the window of implantation and MVD of 37 patients withαSMA and SMM coloring cell number proportion were positive correlation significantly( r=0.472,P=0.000<0.005),(r=0.426 ,P=0.000<0.005),(r=0.512,P=0.000<0.05).Success group during the window of implantation in the uterine artery PI=0.94±0.28,PI=0.87±0.29 failure group,differences between the two groups was not statistically significant(t=0.688,P=0.493>0.05).Conclusion:During the window of implantation in the endometrium of natural killer cells and endometrial angiogenesis was significantly associated with successful pregnancy, may have a certain relationship;uterine artery PI and pregnancy outcome successful has no obviously relationshhip.

Objective To observe the effectiveness and safety of oral anticoagulants and antithrombotic therapy in elderly patients with atrial fibrillation. Methods Patients were divided into anticoagulant group (warfarin) and antithrombotie group (aspirin or clopidogrel) based on the initial treatment. The prothrombin time (PT), activated clotting time (ACT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fihrinogen (FIB), thrombin time (TT), coagulation factor Ⅱ,Ⅴ,Ⅶ,Ⅷ,Ⅸ, and Ⅹ,fibrin degradation product (FDP) and D-dimer were tested at baseline and after therapy in both groups. Results The average treatment period was 44.2±37.5 months in antithrombotic group and 39.0±61.5 months in anticoagulant group. There were six cases of isehemic stroke, one acute artery embolism in right lower limb and three gastrointestinal bleeding in antithrombotic group, while two gastrointestinal bleeding and two fatal hemorrhagic stroke in anticoagulant group. The results of PT, ACT, INR, APTT, FIB, TT, coagulation factor Ⅱ,Ⅴ ,Ⅶ, Ⅷ,Ⅸ,Ⅹ,FDP and D-dimer had no significant differences compared with the baseline in antithrombotic group. However, there were significant increase in PT and INR [(8.4±7.5)s and (0. 93±0. 83)s, both P<0. 05)], and significant decrease in ACT, coagulation factor Ⅱ,Ⅶ, Ⅸ and Ⅹ (all P<0. 05) in anticoagulant group. Conclusions Anticoagulant therapy may he effective in prevention of ischemic stroke in elderly patients with atrial fibrillation. However, it may slightly increase the hemorrhage incidence. The overall adverse events were not significantly reduced.

Objective To evaluate the correlation between the level of CD4+CD25+regulatory T cells in periphend blood and disease severity in patients with sepsis.Methods Thirty-six septic patients and 5healthy controls were enrolled.Septic patients were divided into sepsis group(n=10),severe sepsis group (n=15)and septic shock group(n=11).The lymphocyte was seperated from peripheral blood and marked by PE-CD4 and FTTC-CD25 monoclonal antibody,the level of CD4+CD25+ regulatory T cells was detected by flow cytometry,and the clinical data of APACHE Ⅱ scores of septic patients was considered in 24 hours.The correlation between level of CD4+CD25+ regulatory T cells in peripheral blood and APACHE Ⅱ scores in septic patients was analyzed.Results Compared with the healthy controls [(5.48±0.98)%],the level of CD4+ CD25+ regulatory T cells in sepsis group(10.31±2.32)%,severe sepsis group(14.27 43.33)%,septic shock group(15.32±3.98)% had a significant increase(P＜0.05 or＜0.01).The log value of regulatory T cells in each group correlated positively with the APACHE Ⅱ scores(r=0.829,P=0.032;r=0.868,P=0.021;r=0.913,P=0.009),and the total coefficient of correlation was 0.903(P=0.013).Conclusion The level of CD4+CD25+ regulatory T cells in peripheral blood in septic patients has an abnormal increase,and their levels are related with the severity of disease.

Objective To examine the relationship between premature ventricular contraction(PVC) and microvascular leakage in the myocardium due to microvascular contrast echocardiography(MCE). Methods Thirty eight rats were randomized into 5 groups: control, ultrasound exposure only, contrast agent only, real time MCE and trigger imaging MCE. Anesthetized rats with tail vein catheter were imaged in a 37℃ water bath at left ventricular parasternal short axis view. Optison was injected at a dosage of 5 ml/kg. Frequency was 1.7 MHz, MI= 1.7 and the depth of image at 10 cm. Results PVC was detected in all ultrasound exposure groups, together with petechial hemorrhages and Evans Blue leakage in the scan band. The triggered imaging showed worse effects than real time imaging. No PVC or microvascular leakage was noticed in controls or sham exposed rats. Conclusions Induction of PVC during contrast added echocardiography is associated with microvascular leakage.

Objective To compare the results of stroke risk assessment system in patients with non-valvular atrial fibrillation u-sing CHADS2 and CHA2 DS2-VASc .Methods A total of 420 patients with non-valvular atrial fibrillation were evaluated using CHADS2 and CHA2DS2-VASc ,they were divided into three groups according scores :low risk group(scores 0) ,intermediate risk group(scores 1) ,high risk group(scores≥2) .Compare the average scores and the proportions of three groups of two stroke risk as-sessment system .Results The average score of CHA2DS2-VASc was significantly higher than that′s of CHADS2 (2 .41 ± 1 .93 vs . 1 .39 ± 1 .39 ,P<0 .05) .According to scores of CHADS2 ,the proportions of low risk groups were 34 .5% (145/420) ,intermediate risk group were 28 .8% (121/420) ,high risk group were 36 .7% (154/420) .According to scores of CHA2DS2-VASc ,the propor-tions of low risk group were 16 .2% (68/420) ,intermediate risk group were 23 .3% (98/420) ,high risk group were 60 .5% (254/420) .CHA2 DS2-VASc compared with CHADS2 ,the proportion of low-risk group significantly lower than the latter ,the proportion of high-risk groups significantly higher than the latter(P<0 .05) .Conclusion The scores of CHA2DS2-VASc is significantly high-er than that′s of CHADS2 in patients with non-valvular atrial fibrillation ,there are more patients needs anticoagulation using stroke risk assessment system CHA2 DS2-VASc .

Objective To evaluate the clinical advantages of transradiai approach for percutaneous coronary intervention in elderly patients with acute myocardial infarction.Methods From January 2008 to October 2011,150 elderly patients (average age of 70.4±7.2 yrs) diagnosed with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary invention (PCI).They were divided into transfemoral intervention group (TFI group,n=91) and transradial intervention group (TRI group,n=59).The arrival time at the first balloon inflation,the success rate of reperfusion,the X ray exposure time,the total procedural time,contrast volume,the average in-hospital days,the mean hospital expenses and postoperative complications were compared between two groups.Results The average in-hospital days was shorter in TRI group than in TFI group [(9.3±0.5) days vs.(12.8±0.7) days,P＜0.01].The mean in-hospital expenses was less in TRIgroup than in TFI group [(44707.3±1009.3) RMB vs.(54047.8±1971.6) RMB,P＜0.05].There were no significant differences in the arrival time at the first balloon inflation,the success rate of reperfusion,the X-ray exposure time,the contrast volume between the two groups [(26.7±0.8)minutes vs.(27.7±1.2) minutes,98.3％ (58/59) vs.96.7％ (88/91),(10.8±0.9) minutes vs.(9.6±0.6) minutes,(223.9±9.2) ml vs.(229.8±7.5) ml,respectively,all P＞0.05].The postoperative complications including major bleeding,pseudoaneurysm,radial occlusion without ischemia and the incidence of major adverse cardiovascular events had no statistical differences between the two groups (P＞0.05).The cases of urethral catheterization caused by urinary retention were less in TRI group than in TFI (0 vs.11 cases,P＜0.01).Conclusions Compared with transfemoral approach,the transradial approach is feasible and safe for primary PCI in elderly patients with acute myocardial infarction,and has better clinical advantage and socioeconomic benefit.

Objective:To evaluate and screen the anti-atrial ifbrillation drug with multiion channel targets by micro-electrode chip technology in a rapid atrial pacing (RAP) rabbit model.
Methods:A total of 32 rabbits were randomly divided into 4 groups, n=8 in each group. Potassium channel blocker (TEA) group, Potassium channel blocker (BaCl2) group, Potassium channel blocker (CdCl2) group and Amiodarone group.
The electrode was inserted into right atrium via internal jugular vein with rapid right atrial pacing (600 beat/min) and the effect of each anti-atrial ifbrillation drug on ifeld action potential (fAPD) were measured in different groups.
Results:With 24 hour RAP, the fAPD was prolonged from (176.67 ± 8.66) ms to (196.11 ± 10.76) ms, P=0.012 in TEA group;from (182.22 ± 12.87) ms to (191.11 ± 13.09) ms, P=0.039 in BaCl2 group;from (178.33±7.85) ms to (206.67 ± 9.70) ms, P=0.0015 in CdCl2 group;from (167.38 ± 13.67) ms to (185 ± 15.14) ms, P=0.002 in Amiodarone group.
Conclusion: RAP induced atrial fibrillation in experimental rabbit model is a simple and feasible method for screening the anti-atrial fibrillation drugs, combining with micro-electrode chip technology, it might be used for developing the new product.

Osteofascial compartment syndrome (OFCS) is clinically common and is well known to orthopedic surgeons.Clinicians attach great importance to OFCS because of its severe clinical consequences,and decompression of fascial compartment is often performed in emergency treatment.This article reviews the literature on the threshold of fascial compartment decompression proposed by many scholars in the past and discusses the problems in the clinical diagnosis of acute compartment syndrome,especially the inconsistent pressure thresholds as the indication for emergency decompression surgery.By observing calf fractures patients with tension blister,we found that the pressure of fascia decreased sharply upon the appearance of blisters.Meanwhile,the swelling gradually subsided as well as the clinical manifestations of pain and parasthsia.In view of the uncertainty of various thresholds of fascial decompression and self-decompression,the concepts of myofascial self-release law and muscle-swelling syndrome were first proposed.The author believes that when intracompartmental pressure rises to a point,some unknown mechanisms of fascia can achieve self-decompression.Therefore,no compartment syndrome will take place.We also emphasize that the ' muscle-swelling syndrome'should be strictly distinguished from the soft tissue necrosis caused by crush syndrome and acute limb vascular injury,so as to provide more precise treatment.We believe that without external restrictions such as casts,splints and compression bandages,the muscle-swelling syndrome can achieve self decompression by releasing the pressure in the compartment through tension blisters,and there is no need for fasciotomy.

The presence of tension blister often predicts severe soft tissue damage，which not only increases the risk of wound complications but also prolongs the surgical treatment time. However，the developed tension blister has been proposed as a potential decompressive approach for it may relieve the pressure of osteofascial compartment and improve the likelihood of relieving clinical symptoms，as well as avoid unnecessary surgery in cases of suspected osteofascial compartment syndrome. Recently，the osteofascial system has been increasingly recognized that associations were found between the tension blister and osteofascial self-release processing. Thus，the timing of blister occurrence and regression substantially influences physicians′ clinical decisions，making blister management as part of the treatment of fractures. In this review，the authors give an overview of the characteristics，mechanism，stress reduction effect，prevention，current treatment status and complications of the fracture-related tension blister，hoping to help orthopedic physicians understand and treat the tensile blister.