Objective To investgate the proper perioperative management of Debakey Ⅰ aortic dissection by new type of three branches aortic arch covered stent graft implantation. Methods A total of 56cases with Debakey Ⅰ aortic dissection were enrolled into the study and operated by new type of three branches aortic arch covered stent graft implantation from July 2009 to August 2010. Results The cardiopulmonary bypass time during the operation was 90. 0 -248.0 min( median time 180. 6 ains) ,aortic cross clamp time was 69. 0 - 180. 0 min(median time 108. 2 mins) ,circulation arrest time was 17.0 -37.0 min ( median time 22. 6mins) ,the time using reathing apparatus was 16.0 -260.0 hours (median time 42. 8 hours),ICU residence time was 3.0 -23. 0 days( median time 6. 6 days). Fifty-four patients got well and were discharged. One patient died of multi-organ failure postoperatively and another died of large area of acute myocardial infarction. After the operation, six cases had acute renal failure, five cases had tracheotomy, three cases had reoperation for hemorrhage,one case had retardant pericardial tamponade, one case suffered from spinal cord injury, one had cerebral hemorrhage, and five cases had refractory arrhythmias. Conclusion The new type of three branches aortic arch covered stent graft simplified the procedures of aortic arch operation and lowered the operative risk in treatment of Debakey Ⅰ aortic dissection. Properly control of blood pressure and pain before surgery, shorten circulatory arrest time, maintain good organ perfusion seem to be the key points to improve the prognosis in patients with aortic dissection.

Objective Few studies are reported on the radicular groove and root canal variation of the mandibular first premolar.This study aimed to observe the root canal system and root variation of the mandibular first premolar by cone-beam computed tomography (CBCT).Methods We selected CBCT images of 643 mandibular first premolars of 336 patients and subjected the data obtained to statistical analysis.Results Of the 643 mandibular first premolars, 637 (99.1％) had a single root and the other 6 had double roots;502 (78.1％) had a single root canal, 133 (20.7％) had two, 5 (0.78％) had three, and 3 (0.47％) presented C-shaped root canal morphology.The average length of the 643 mandibular first premolars was (13.2±1.5) mm and the mean distance from the apical foramen to the anatomical apical end of the root was (0.93±0.35) mm.Totally, 123 (19.1％) of the mandibular first premolars had a radicular groove, of which 94 (76.4％) had double root canals and the root canal systems included typesⅠ in 24 (19.5％), Ⅱ in 2 (1.6％), Ⅲ in 19 (15.4％), Ⅳ in 1 (0.8％), Ⅴ in 69 (56.1％), and Ⅶ in 3 (2.4％).Conclusion The root canal system of the mandibular first premolar has a significant variation.CBCT can reveal the complex anatomical structure of the mandibular first premolar and provide reliable evidence for the root canal treatment.

Objective To investigate the effect of different pressures of hyperbaric oxygen (HBO) treatment on neuropathic pain (NP) in rats.Methods Twenty-four healthy male Sprague-Dawley rats were randomly divided into 4 groups (n =6 each):sham operation group (group S),NP group,treatment with HBO at 2.0 atmosphere absolute group (group HBO2.0) and treatment with HBO at 2.5 atmosphere absolute group (group HBO2.5).The animals were anesthetized with intraperitoneal 5 ％ chloral hydrate 300 mg/kg.NP was induced by chronic constrictive injury.The left sciatic nerve was exposed and 4 loose ligatures were placed on the sciatic nerve at 1-mm intervals with 4-0 silk thread.After the rats were placed in the HBO chamber,the pressure was increased at a rate of 10 kPa/min until the desired pressure was reached,and then the pressure was maintained at this level for 60 min.The pressure was then decreased at a rate of 10 kPa/min until the normal pressure was reached.HBO treatment was performed once a day for 5 consecutive days starting from 1st day after operation in groups HBO2.0 and HBO2.5.While the rats were only placed in the HBO chamber and stayed for 100 min in groups S and NP.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 0,1and 2 h after leaving the HBO chamber (T0.2).Results Compared with group S,MWT was significantly decreased and TWL was shortened in group NP (P ＜ 0.05).Compared with group NP,MWT was significantly increased and TWL prolonged at T1 during the treatment (P ＜ 0.05),while no significant change was found in MWT and TWL at T2 during the treatment in groups HBO2.0 and HBO2.5 (P ＞ 0.05).There was no significant difference in MWT and TWL at each time point during the treatment between groups HBO2.0 and HBO2.5 (P ＞ 0.05).Conclusion Treatment with different pressures of HBO can reduce NP in rats,but the change in pressure dose not affect the analgesic efficacy.

Objective To establish a new multiplex-PCR assay to improve the detection rate of mutations in the DMD gene in Chinese patients. Methods A retrospective review of DMD deletion spectrum of 355 DMD patients with deletions all over the gene was performed. All deletions were confirmed by " one-step approach" diagnostic procedure and MLPA analysis. The exons with high frequency of mutations were identified to constitute the amplification system and the PCR conditions were optimized. Results Two new multiplex-PCR assays were established. Assay one was used to detect 10 exons including exon 5, 8, 17, 44, 45, 47, 49, 50, 51 and 52 of DMD gene, in two PCR sets. The theoretical detection rate would be 92% (326/355). Assay two was used to detect 5 exons including exon 12, 19, 35, 43 and 54, which could be used to screen additional 5% (17/355) deletion cases. The method was validated in other 22 DMD patients. Multiplex-PCR results were completely identical to the MLPA results in all 22 DMD patients. Conclusions The two multiplex-PCR assays were established based on the analysis of 355 Chinese DMD patients with gene deletions. It is believed that the new approach would be more applicable for deletion detection on the Chinese DMD patients since the DMD cases involved were from the whole country.

Objective Through the investigation and analysis to "Chinese Medical Digest" and its relative periodicals to get a general idea of the survival and situation of these periodicals and to establish the pattern for their survival and development. Methods Such methods as telephone consultation, questionnaire survey, interview, and conference discussion were adopted to collect the relative information of medical digest periodicals and thus an analysis was made upon it. Results There were 18 kinds of "Chinese Medical Digest" periodicals originally. Of all these 18 kinds of the periodicals, 6 kinds are still publishing, 10 kinds have transferred its nature to first-hand literature periodical, and 2 kinds have ceased their publishment. Conclusion As a result of the computer, the network and the full text database development, the survival of medical digest periodicals are endangered. However, regarding to the different domain of subject, different reforming measures should be taken.

Objective To study early face processing of mild cognitive impairment patients by using ERP method．Methods Sixteen healthy old man(normal group)and sixteen mild cognitive impairment patients(MCI group)served as subjects in experiment．Two runs of 300 stimuli(duration：50ms)of 3 facial and 3 non-facial pictures were randomly presented with equal probability(ISI：from 1000ms to 1500ms randomly)，and the subjects were asked to react to facial stimuli and non-facial stimuli by pressing the left button and risht button respectively as quickly as possible．Thirty-two channels electroencephalogram(EEG)Was recorded by Neuroscan Nuamps Systern．Results 1)Specific-face component N170 was found in both groups．Which was distributed at the temporal-occipital region．2)Compared with N170 in normal group，N170 amplitude Was significantly lower((-4．42±0．28)Μv vs(-7．00±0．28)Μv，F=41．52，P<0．01)at temporal-occipital region and delayed((158．91±2．17)ms vs(140．97±2．17)ms，F=34．09，P<0．01) in mild cognitive impairment group．Conclusion The early face processing mechanism of mild cognitive impairment patients may be different from normal people．

Objective To observe the morphologic changes of pancreatic islets in diabetic rats and the protective effects of rosiglitazone natrium (RSG) on the remnant islet.Methods 8 rats were randomly selected from 68 male Sprague-Dawley rats for normal control group (group A),the rest were administered with STZ,and those with FBG≥16.7mmol/L were served as diabetic models,then the rats were randomly assigned as RSG-treated group (group B,n=24).RSG were applied via intragastric administration at a dose of 5mg/(kg·d) in group B.72 hours after the administration of STZ and 1-,2-,4 and 7 week after the administration of RSG,4 rats were randomly selected respectively,pancreas specimens were obtained and preserved.The morphologie changes were observed under light microscopes and transmission electron microscope.Results The diabetic symptoms of the rats in groupe B lessened significantly,and the FBG levels were decreased gradually,the morphologic injuries of remnant islet were recovering. The amount of secretory granule in beta cells increased gradually.Conclusion Rosiglitazone natrium call attenuate morphologic injuries of the islets and protect the remnant islet in type 1 diabetes mellilus rats.

Objective Postoperative cognitive dysfunction (POCD) is a common complication of cardiac surgery, which seriously affects the prognosis of the patient.This study aimed to explore the risk factors for early POCD in patients undergoing cardiac valve surgery and the correlation between early POCD and the serum S100B protein level.Methods Eighty patients underwent mitral valve replacement surgery in combination with tricuspid plasty.At 1 day before and 5 days after surgery, we assessed the cognitive function of the patients and divided them into a POCD and a non-POCD group.We obtained such data as the age, sex, education, New EuroSCORE Ⅱ, and preoperative NYHA cardiac function grades and left ventricle ejection fraction (LVEF) of the patients, collected the venous blood to determine serum S100B protein concentration by ELISA, and analyzed the independent risk factors of early POCD using single-factor and binary logistic regression analyses.Results POCD was found in 20 (25%) of the patients, , Logistic regression analysis showed the independent risk factors for early POCD to be hyperglycemia (OR=6.038, 95% CI: 1.202-30.337), operation time (OR=6.423, 95% CI: 1.276-32.332), and aspartate aminotransferase (AST, 2 times higher than normal) (OR=12.878, 95% CI: 2.289-72.445).The serum S100B protein concentrations in the POCD group were (1.9±0.3) μg/L and (1.7±0.4) μg/L at 48 and 72 hours after cardiopulmonary bypass, significantly lower than (2.4±0.4) μg/L and (2.1±0.3) μg/L at 30 minutes and 24 hours (P<0.05), and so was it in the non-POCD group at 72 than at 48 hours postoperatively ([1.4±0.4]) vs [1.5±0.4] μg/L, P<0.05).Conclusion Long operation time, perioperative hyperglycemia and high AST are independent predictors and the serum S100B protein level is a significant marker of early POCD.

Objective To evaluate the relationship between the anesthesia factor and myocardial injury in the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods Eightyeight patients of both sexes,aged 42-71 yr,weighing 59-83 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association Ⅱ or Ⅲ),scheduled for elective coronary artery bypass grafting with CPB,were divided into 4 groups (n =22 each) using a random number table:routine anesthesia control group (group C),dexmedetomidine-based anesthesia group (group D),sevofluranebased anesthesia group (group S) and dexmedetomidine combined with sevoflurane anesthesia group (group DS).After tracheal intubation,0.2％-2.1％ sevoflurane was inhaled until the beginning of CPB in S and DS groups.In D and DS groups,dexmedetomidine was intravenously infused as a loading dose of 1 μg/kg over 10 min before induction of anesthesia,followed by an infusion of 0.4 μg · kg-1 · h-1 until the end of surgery.Before induction of anesthesia,before CPB,after the end of CPB,immediately after the end of surgery and at 24 h after surgery,venous blood samples were collected for determination of plasma creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) concentrations by immunofluorescence.The restoration of spontaneous heart beat and adverse events such as hypotension,malignant arrhythmia,cardiac arrest and respiratory depression during surgery and within 24 h after surgery were recorded.Results Compared with group C,the plasma concentrations of CK-MB and cTnI were significantly decreased in the other three groups (P＜0.05).The plasma eoncentrations of CK-MB and eTnl were significantly lower in group DS than in S and D groups (P＜0.05).There were no significant differences in the rate of restoration of spontaneous heart beat among the four groups (P＞ 0.05).No adverse events were found during surgery and within 24 h after surgery in the four groups.Conclusion Dexmedetomidine combined with sevoflurane anesthesia is helpful in reducing myocardial injury and provides better efficacy than either alone in the patients undergoing cardiac surgery with CPB and is more suitable for cardiac surgery with CPB.

Objective To investigate the efficacy and safety of oxycodone hydrochloride controlled-release tablets combined with gabapentin in the treatment of painful diabetic neuropathy.Methods Eighty patients with painful diabetic neuropathy were divided into group A and group B with 40 cases each by random digits table.Patients of group A received simple oxycodone hydrochloride controlled-release tablets,while patients of group B received oxycodone combined with gabapentin.The intensity of pain, oxycodone dosage, quality of life and adverse effect in two groups was observed and compared.Results The pain was obviously relieved in two groups, and the effective analgesic rate at 21-28 d after treatment in group B was superior to group A[95.0% (38/40) vs.62.5% (25/40)], there was significant difference between two groups (P＜0.05).Numerical rating scale NRS score at 28 d after treatment in group B and group A was 1.2 ± 0.3 and 2.8 ± 0.5 respectively,and there was significant difference between two groups (P＜ 0.01 );the oxycodone dosage at 28 d after treatment in group B was lower than that in group A[(32.2 ± 4.3 )mg vs.(40.3±5.5 ) mg], and there was significant difference between two groups (P ＜ 0.05 ); the quality of life in group B was superior to group A, and there was significant difference between two groups (P ＜ 0.05 or ＜ 0.01 );the incidence of dizzy at 7, 14 d after treatment in group B was higher than that in group A[35.0% (14/40) vs.15.0% (6/40) and 30.0% (12/40) vs.10.0% (4/40)],and there was significant difference between two groups (P ＜ 0.05 ).Conclusion Oxycodon hydrochloride controlled-release tablets combined with gabapentin is effective and safe for the management of painful diabetic neuropathy.