Objective To explore the relations between physiological retrogressive auricular fibrillation and organical pathological auricular fibrillation in elderly patients.Methods 36 cases paroxysmal auricular fibrillation in elderly patients without organical pathogeny were monitored for 24 hours using dynamic electrocardiogram.The attack time and frequency of paroxysmal auricular fibrillation,the change of heart rate,and other type arrhythmia complexing were analyzed.Results Most cases of paroxysmal auricular fibrillation in elderly patients were companied with arrhythmia,supraventricular arrhythmia occupy in the first place especially.The ventricle rate was slow in most cases.The attack had different rhythm in day and night,there were two flows and one edd in one day.Conclusion The elderly auricular fibrillation is associated with the physiological anaplasia of auricular muscle and artro-ventricular junction area directly.It also relates to the heighten excitability of pneumogastric nerve and secretive conduction.

Objective: To explore influence of short-term intervention of different doses rosuvastatin on plasma levels of thrombomodulin (TM) and high sensitive C reactive protein (hsCRP) in patients with acute coronary syndrome (ACS). Methods: A total of 32 ACS patients were enrolled, randomly and equally divided into rosuvastatin 10mg group and rosuvastatin 20mg group, and another 16 patients without coronary heart disease were enrolled as normal control group. Enzyme linked immunosorbent assay (ELISA) was used to measure plasma levels of TM and hsCRP in two rosuvastatin groups before and after treatment and in normal control group at admission. Adverse drug reactions and incidence rates of cardiovascular events within one month were observed in two rosuvastatin groups. Results: Plasma levels of TM and hsCRP in two groups of ACS patients were both significantly higher than those of normal control group before treatment, P<0.001 all; compared with before treatment, there were significant decrease in levels of TM [10mg group：(54.09±52.45) μg/dl vs. (15.65±2.30) μg/dl，20mg group：(70.27±62.43) μg/dl vs. (19.86±5.49) μg/dl] and hsCRP [10mg group：(126.35±76.08) ng/ml vs. (54.85±45.30) ng/ml，20mg group：(125.35±60.29) ng/ml vs. (58.14±53.54) ng/ml] in two rosuvastatin groups after treatment 7d, P<0.01 all; But there were no significant differences in influences of two doses on plasma levels of TM and hsCRP in ACS patients, P＞0.05 all. There was no significant difference in incidence rate of adverse drug reactions between two rosuvastatin groups during follow-up (P>0.05); compared with rosuvastatin 10mg group, there was significant decrease in incidence rate of major adverse cardiovascular events（MACE）: Relapse angina pectoris (62.50% vs. 18.75%, P<0.01) in rosuvastatin 20mg group. Conclusions: Early intensive statins medication （rosuvastatin 20mg）can decrease plasma levels of thrombomodulin and high sensitive C reactive protein, and rosuvastatin 20mg/d can effectively decrease incidence rate of cardiovascular events without significant increase incidence rate of adverse drug reactions in ACS patients.

Objective To analyze the epidemic characteristics of the hand-foot-mouth disease (HFMD) in four years before and after EV71 vaccine inoculation, and to provide a basis for better EV71 vaccination and prevention and control of HFMD. Methods The descriptive epidemiology method was used to analyze the monitoring data of HFMD from 2013 to 2020 and EV71 vaccination from 2017 to 2020 in Xinwu District of Wuxi City. Results A total of 9 589 HFMD cases including 104 severe cases (accounting for 1.08%) were reported in four years before EV71 vaccination, and the reported average annual incidence rate was 431.15/100 000. A total of 7 396 HFMD cases including 21 severe cases (accounting for 0.28%) were reported in four years after vaccine inoculation, and the reported average annual incidence rate was 325.28/100,000. Annual incidence rate and severe illness rate decreased significantly before and after vaccine inoculation. The HFMD incidences displayed two epidemic peaks, from May to June and from October to November. The three streets with the highest average annual incidence were Jiangxi, Meicun, and Shuofang. The HFMD cases were mainly children under 5 years old, and there were more men than women. A total of 394 samples were sent for examination from 2013-2020, and 231 were positive, with a total positive rate of 58.63%. There were significant changes in the etiological composition before and after vaccine inoculation. The composition of EV71 virus decreased significantly (χ²=69.70, P<0.05), while CA16 and CA6 increased significantly (χ²=22.35, P<0. 05). From 2017 to 2020, a total of 12 472 people were inoculated with EV71 vaccine in Xinwu District of Wuxi City, with estimated annual vaccination rates of 3.78%, 10.96%, 8.40% and 7.63%, respectively. Conclusion There is no significant change in time, region and population distribution of HFMD before and after EV71 vaccination in Xinwu District of Wuxi City, but the annual incidence rate and severe illness rate show a decreasing trend, and the dominant intestinal pathogens have changed. It is suggested to strengthen the use of EV71 vaccine and the development of multivalent HFMD-related vaccine.

Animal operation training is an important course that medical students need to study before they get into their clinical practice.Because there is no cavity mirror operation training standard and teaching experience for interns,we have put forward and conducted the animal laparoscopic teaching applications in surgery teaching,and evaluated the teaching effect.Through training,the clinical medical students have personally experienced and learnt basic operation skills of laparoscopic surgery,which is an organic link from textbooks to clinical practice,and at the same time they have improved the ability of clinical practice,cultivate and strengthen their interest in laparoscopic surgical skills training and operation,which help them lay a good foundation for clinical practice.

BACKGROUND: In patients with obstructive sleep apnea(OSA),the degree of severity of OSA is mostly related to the sleep time spent in the supine position. According to the apnea-hypopnea index(AHI), positional and n onpositional OSA has been distinguished.OBJECTIVE: To compare the clinical characteristics of positional and nonpositional OSA and investigatethe relationship between sleep position and respiratory function of patients with OSA.DESIGN: A comparative clinica] observation based on the OSA patients.SETTING: Center of Sleep Disorders,Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA.PARTICIPANTS: From October 1998 to May 2002,225 patients were examined with overnight polysomnography in the Center of Sleep Disorders,Department of Respiratory Disease, Nanjing General Hospital of Nanjing Command. According to the inclusion criteria of ① AHI≥10 times/hour;② Sleep time in supine and lateral positions≥30 minutes; ③ Over 20years of age; 225 patients were selected from the total of 415 consecutive patients,including 63 with positional and 162 with nonpositional OSA.METHODS: All patients received overnight monitoring with HMS-5500polysomnography system(Respironics Inc USA) in the sleep laboratory. Queries for a detailed case history and physical examination were performed with the pulmonary functions evaluated with body p lethysmography. The clinical data and results of polysomnographic and pulmonary function tests were compared between the two groups of patients and a multiple stepwise regression analysis was employed to evaluate the determinant factors for sleep position dependence of the patients' condition.MAIN OUTCOME MEASURES: Main outcome: Comparisons of the clinical data,polysomnographic result and pulmonary function between the two groups. Secondary outcome: Correlation between classification of OSA and the clinical data.RESULTS: Totally 63 (28%) of the 225 OSA patients were identified as the positional type,who had significantly greater body mass index (BMI)then the nonpositional type patients [(43.46 ± 16.43) kg/m2 vs (23.90 ± 12.36) kg/m2,t =3. 977,P<0.01]. Except for sleeping time in lateral and supine positions, minimal SatO2 and basic SatO2 before the matching for BMI,all the other factors in polysomnograms of the two groups were significant different(P<0.05 or P<0.01). After BMI matching,all the measurements were identical to those recorded for the primary grouping with the exception of nocturnal limb movement frequency,which differed but insignificant between the two groups. The pulmonary function in the two groups was no significant difference(P>0.05) . Multiple stepwise regression analysis indicated that AHI and BMI were the two determinant factors for positional dependence of OSA with a predictive power of 26. 2%. Linear correlation analysis showed correlation of AHI and SatO2 with BMI in the whole group and nonpositional group(P<0.05 or P<0.01),but not in the positional group (P>0.05).CONCLUSION: About one-third of the OSA patients shows sleep position dependence,who may respond favorably to sleep position training. Sufficient patency can be retained in the upper airway of these patients to relieve respiratory obstruction during sleep and improve the respiratory function.

Objective To assess the clinical efficacy of acupuncture at the sphenopalatine ganglion for the treatment of patients with moderate to severe allergic rhinitis.Methods 42 cases of moderate to severe allergic rhinitis patients in Otorhinolaryngology clinic of Tongren Hospital between August 2012 to November 2013 were randomized into a treatment group and a control group. The treatment group was treated by acupuncturing sphenopalatine ganglion, once per week, altogether 4 times. The control group was treated by acupuncturingFengchi(GB20),Baihui(GV20),Yingxiang(GV29),Shangxing(GV23),Taiyang(EX-HN5), Quchi(LI11) andZusanli (ST36) was used in the control group, 3 times per week for 4 weeks. The changes of the Total Nasal Symptoms Score (TNSS) and the Total Non-Nasal Symptom Score (TNNSS) were evaluated before and after treatment. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was used to evaluate the quality of life.Results One week after treatment, the scores of TNSS, TNNSS and RQLQ in both groups were significantly improved than before the treatment (treatment group: 5.0[4.0, 6.0]vs. 9.0[7.0, 10.0], 1.0[1.0, 1.5]vs. 3.0[3.0, 3.0], 44.0[35.5, 50.0]vs. 60.0[53.5,75.0]; control group: 6.0[5.5, 8.0]vs. 10.0[8.5, 10.1], 2.0[2.0, 3.0]vs. 3.00[3.0, 3.0], 50.0[45.5, 58.0]vs.43.0[27.0, 48.0]; allP<0.01); the scores of TNSS, TNNSS and RQLQ 1 week after treatment in the treatment group were significantly improved than those in the control group. The scores of TNSS(2.0[1.0, 3.0]vs. 3.0[2.0, 4.5]), TNNSS(1.0[0.0, 1.0]vs.2.0[2.0, 3.0]) and RQLQ(24.0[19.0, 29.0]vs. 43.0[27.0, 48.5])4 week after treatment in the treatment group were significantly improved than those in the control group(allP<0.01).Conclusions Acupuncture at the sphenopalatine ganglion could relieve the symptoms and improve the quality of life in patients with moderate to severe allergic rhinitis, and show more rapid and persistent therapeutic effect. It may be superior to the common acupuncture.

Purpose: To apply staged arteriovenous reversal in the treatment of extensive and diffuse arterial occlusive disease of the limb. To avoid amputation of the limb or to limit it to necrosed segments.
Methods: Exactly 138 patients (a total of 153 severely ischemic limbs) were applied staged arteriovenous reversal (AVR) from January 1984 to December 1995. Generic-specific involvement totaled 106 men and 32 women. Their ages ranged from 24 to 71, averaging 48.7 years. The duration of symptoms ranged from 15 days to 17 years. A total of 112 patients were diagnosed as having Buerger's disease, and 25 had arteriosclerosis. In one patient, the popliteal artery was completely obstructed by acute emboli of atheromatous plaques. Three patients with Buerger's disease had not benefited from lumbar sympathectomy or partial adrenalectomy done several years ago. According to different levels of extensive and diffuse arterial occlusion, arteriovenous reversal was formed at three different sites: (1) high-deep reversal, produced between the external iliac, common femoral, or superficial femoral artery and the superficial femoral vein; (2) low-deep reversal between the distal popliteal artery and tibioperoneal venous trunk; (3) superficial reversal, established between the distal popliteal artery and distal portion of the long saphenous vein.
Results: Until June 1996, a total of 132 patients were followed up for 0.5-12 years, averaging 6.5 years. The postoperative results of all limbs except 12 in this series are excellent or good. Cardiac dysfunction does not occur, nor does the marked elevation of venous pressure of the limb.
Conclusion: We consider that if the deep venous trunks are patent, the limbs with extensive arterial occlusion are indicated for staged AVR if severe ischemia is present and all other therapeutic methods have failed. Even with necrotic limbs, this operation may lower the level of amputation. The authors suggest that staged arteriovenous reversal is a new and effective approach in the treatment of extensive arterial occlusive disease of the limb.

Objective To find direct effect of Chinese herbs Bu Gu Zhi (Psoralea corylifolia L) and Bai Zhi (Dahurian angelica root) Extracts on melanocyte adhesion and migration in vitro. Methods Ethanol extracts obtained from two kind of Chinese medicinable herbs were tested. Human melanocytes were obtained from neonatal foreskins and 48-well culture dish covered with fibronectin were used to perform melanocyte adhesion assay; Motility was assessed using the micropore filter method. Results: The extracts of Bu Gu Zhi(Psoralea corylifolia L), Bai Zhi(Dahurian angelica root) obviously showed an effect in increasing of human melanocyte adhesion and migration on fibronectin. Conclusion It is suggested that Buguzhi(Fructus Psoraleae) and Baizhi(Radix Angelicae Dahuricae) might induce melanocyte adhesion and/or migration in the treatment of vitiligo.

OBJECTIVE: To optimize the MR imaging protocol for coronary arterial wall depiction in vitro and characterize the coronary atherosclerotic plaques. MATERIALS AND METHODS: MRI examination was prospectively performed in ten porcine hearts in order to optimize the MR imaging protocol. Various surface coils were used for coronary arterial wall imaging with the same parameters. Then, the image parameters were further optimized for high-resolution coronary wall imaging. The signal-noise ratio (SNR) and contrast-noise ratio (CNR) of images were measured. Finally, 8 human cadaver hearts with coronary atherosclerotic plaques were prospectively performed with MRI examination using optimized protocol in order to characterize the coronary atherosclerotic plaques. RESULTS: The SNR and CNR of MR image with temporomandibular coil were the highest of various surface coils. High-resolution and high SNR and CNR for ex vivo coronary artery wall depiction can be achieved using temporomandibular coil with 512 x 512 in matrix. Compared with histopathology, the sensitivity and specificity of MRI for identifying advanced plaques were: type IV-V (lipid, necrosis, fibrosis), 94% and 95%; type VI (hemorrhage), 100% and 98%; type VII (calcification), 91% and 100%; and type VIII (fibrosis without lipid core), 100% and 98%, respectively. CONCLUSION: Temporomandibular coil appears to be dramatically superior to eight-channel head coil and knee coil for ex vivo coronary artery wall imaging, providing higher spatial resolution and improved the SNR. Ex vivo high-resolution MRI has capability to distinguish human coronary atherosclerotic plaque compositions and accurately classify advanced plaques.
Aged, 80 and over ; Animals ; Coronary Artery Disease/*diagnosis ; Coronary Vessels/*pathology ; Diagnosis, Differential ; Disease Models, Animal ; Humans ; *Image Enhancement ; Magnetic Resonance Imaging/*methods ; Male ; Plaque, Atherosclerotic/*diagnosis ; Prospective Studies ; Sensitivity and Specificity ; Swine

OBJECTIVETo investigate the effects of 17β-estrogen on expressions of C-reactive protein (CRP) and its mRNA in vascular smooth muscle cells(VSMCs).

METHODSImmunocytochemistry was used to detect CRP level in normal VSMCs. The expressions of C-reactive protein and p-ERK1/2 in Ang-II-stimulated VSMCs were evaluated with Western blot. C-reactive protein mRNA was examined with RT-PCR.

RESULTS17β-estrogen had no effect on cell morphology and C-reactive protein expression in normal VSMCs; however, C-reactive protein and mRNA, as well as p-ERK1/2 were decreased in Ang-II-stimulated VSMCs after 17β-estrogen treatment in a concentration-dependent manner.

CONCLUSION17β-estrogen may inhibit the expression of C-reactive protein and its mRNA in Ang-II-stimulated VSMCs via ERK1/2 signal transduction pathway in a concentration-dependent way.

Animals ; C-Reactive Protein ; genetics ; metabolism ; Cells, Cultured ; Estrogens ; pharmacology ; Male ; Muscle, Smooth, Vascular ; cytology ; Myocytes, Smooth Muscle ; drug effects ; metabolism ; RNA, Messenger ; genetics ; Rats ; Rats, Sprague-Dawley