Recent studies on the role of viable myocardium in revascularization are hot spots.The definition of viable myocardium,multimodality imaging in the assessment of myocardial viability,Meta analyses related to the value of viable myocardium in revascularization,prospective randomized trials,and factors affecting the prognosis of patients after revascularization are reviewed in this article.

Objective To probe the feasibility, indications and efficacy of damage control orthopedics (DCO) in treating severe multiple injuries combined with fractures. Methods A retrospective analysis was done on the clinical data of 31 patients with severe multiple injuries combined with fractures treated by DCO from 1998 to 2008. Results Of all patients, 18 patients were combined with pelvic fractures and hemorrhage. Bilateralis hypogastric artery ligation was performed early in 17 patients and nonage pelvis external fixation was performed in 12. Eleven multiple trauma patients combined with femoral fractures received primary debridement and temporal external fixation for further definitive internal fixation. Two patients with spinal fractures combined with spinal cord compression received primary simple decompression. All patients received resuscitation in ICU for average 4.3 days (1-11 days). There was one death due to hemorrhagic shock. Conclusions DCO well conforms to pathophysiological character of the wounded. Early DCO and later integrated treatment are key to enhancement of the survival rate of the multiple trauma patients.

Objective To evaluate the change of extended spectrum β-lactamase (ESBLs) Producing Klebsiella Pneumoniae (ESBLs-KPN) and Escherichia coli (ESBLs-ECO) causing nosocomial infection after antimicrobial intervention. Methods We regularly monitored the data on the yearly consumption [defined as daily dose (DDD) per 1 000 patient-days] of frequently used antibiotics from Dec. 2004 to Dec. 2007. From Jan. 2005 to Dec. 2007, we monitored the resistance of frequently used antibiotics and the timely integrative antimicrobial intervention was based on the outcome of antimicrobial resistance. We also monitored the isolation rate of ESBLs-KPN and ESBLs-ECO causing nosocomial infection. The departments studied were the experimental group and other comparable medical departments were the control group(ICU was excluded).Results The isolation rate of ESBLs-KPN ((43.90%)) and ESBLs-ECO (45.83%) in the experimental group was higher than that in the control group (28.04% and 24.90%, respectively) before the intervetion (P＜0.05). The isolation rate of ESBLs-KPN decreased (from 26.47% to 17.65%) in the experimental group and that in the control group increased ( ESBLs-KPN: from 34.18% to (52.94%;) ESBLs-ECO: from 47.13% to 63.78%) from 2005 to 2007 (P＜0.05). The isolation rate of ESBLs-KPN and ESBLs-ECO in the experimental group was lower than that in the control group after the antimicrobial intervention (P＜0.05). Usage of ceftazidime and cefoperazone/sulbactam and imipenem was reduced and the consumption of cefepime was increased in the experimental group ((P＜0.05)). Consumption of ceftazidime and cefoperazone/sulbactam and cefepime was increased. Conclusion The prevalence of ESBLs-KPN and ESBLs-ECO may be decreased after the integrative antimicrobial intervention.

Objective　To study the causes and management of the reoperation after cholangiointestiostomy(CIS). Methods　A retrospective analysis was made on the clinical data of 28 cases of reoperation after CIS from June 1995 to June 1999. Results　Among the 28 cases, 26 cases(92%) had CIS anastomotic stenosis. Of the 26 cases, 9 cases accompanied with left hepatobiliary duct stenosis, 3 cases with right hepatobiliary duct stenosis, 5 cases with left and right hepatobiliary ducts stenosis. 9 cases with biliary reflux comfirmed by barium meal radiography, all of the 9 cases were subjected to a choleduodenostomy. Of the 28 patients, 3 underwent reanastomose after excision the primary anstomosis, 8 operated with hilar bile duct reform and left lateral hepatolobectomy, 2 with left hepatic duct jejunostomy and hilar bile duct jejunostomy. 15 cases with intrahepatic bile duct jejunal Roux-en-Y anastomosis, after resolved the intrahepatic bile duct stenosis. Conclusions　The basic cause of reoperation after CIS is anastomotic stenosis, the other causes are as follows: the selected operation is unsuitable, the intrahepatic bile duct stenosis is not resolved, and the stonedoes not clean out completly. When reoperation is performed on these cases, the following principles must be abided by: romoving all the stones, resolving the stenosis, making a clear drainage; and performing hepatic lobectomy, anastomotic sustaining and drainage, and cholefibroscopic management must be done if needed.

Objective To study the schizophrenia and depression recognition rate in the mental health literacy.Methods Search and select the published questionnaire survey studies literature about mental health literacy.Those studies were analyzed by software RevMan 5.2.Results 10 researches entered accorded with the including criteria,a total of 27 275 samples,12 791 of the respondents recognized schizophrenia.10 499 respondents recognized depression.Meta-analysis results showed that the sum of people with schizophrenia recognition rate was 47％ (95％ CI 24％-69％).The sum of people with schizophrenia recognition rate was 45％ (95％CI 31％-59％).Conclusions People from different areas have a higher recognition rate than that of depression.

Objective: To study the effects of propafenone on action potential (AP) of rabbit ventricular myocytes with the tonic block and use-dependent block of transient sodium current (INa-T). Methods: A total of 10 adult New Zealand white rabbits were sacriifced and 10 individual ventricular myocytes were isolated by enzyme digestion method. Microelectrode technologies were used to record AP-related parameters: maximum diastolic potential (MDP), maximum rate of rise of the action potential upstroke (Vmax), action potential amplitude (APA) and action potential duration at 20%, 50% and 90% (APD20, APD50 and APD90).INa-T was measured, I-V curves and peak currents at different frequencies were detected by whole cell patch clamp before and after propafenone perfusion at 10 μmol/L. Results: There was no statistical difference in MDP at before and after propafenone perfusion as (-80 ± 6) mV vs (-82 ± 5) mV,P>0.05. After perfusion, APA was signiifcantly decreased as (95 ± 12) mV vs ( 125 ± 10) mV,P<0.05, the Vmax slowed down as (330 ± 43) V/s vs (420 ± 54) V/s,P<0.05, while APD20, APD50 and APD90 were unchanged as (8 ± 2) ms vs (6 ± 2) ms,P>0.05, (16 ± 3) ms vs (12 ± 3) ms,P>0.05 and (86 ± 14) ms vs (85 ± 12) ms,P>0.05. After propafenone perfusion, I-V curve ofINa-T was shifted upward and the peak current was decreased as (3001 ± 383) pA vs (4193 ± 378) pA, P<0.05. Before perfusion, when stimulated at 0.06 Hz, 1 Hz, 2 Hz, 5 Hz and 10 Hz, there were no signiifcant use-dependent block inINa-T , and no real difference inINa-T between the 10th and 1st pulse,P>0.05. After perfusion, no significant use-dependent block was observed when stimulated at 0.06 Hz and 1 Hz,P>0.05, while at 2 Hz, 5 Hz and 10 Hz, propafenone perfusion demonstrated signiifcant use-dependent block uponINa-T with the inhibition fractions of (22 ± 11)%, (38 ± 14)% and (52 ± 17)% respectively, those were signiifcantly different from the inhibition fractions at either 0.06 Hz or 1Hz,P<0.05. When the inhibition fractions were compared by each 2 conditions, allP<0.05. Conclusion: Propafenone may slow down the Vmax of AP, reduce APA and without the impact on APD; the effects onINa-T is not only in tonic block, but also more obviously in use-dependent block in isolated ventricular myocytes of New Zealand rabbit. Such inlfuences minimized the impact on QT interval and meanwhile, decreased the incidence of brad arrhythmia.

Objective To investigate the value of Cedars-Sinai quantitative gated SPECT (QGS) phase analysis for left ventricular synchrony assessment in healthy subjects.Methods Seventy-four healthy subjects (41 males,33 females,average age:(60±13) years) underwent both rest and exercise 99Tcm-MIBI G-MPI.QGS software was used to analyze the reconstructed rest gated SPECT images automatically,and then the parameters of left ventricular synchrony including phase bandwidth (BW) and phase standard deviation (SD) were obtained.The influences of gender and age (age＜60 years,n =36; age ≥ 60 years,n =38) on left ventricular systolic synchronicity were analyzed.The phase angle for original segmental contraction was measured to determine the onset of the ventricular contraction using 17-segment model.Forty healthy subjects were selected by simple random sampling method to evaluate the intra-observer and interobserver repeatability of QGS phase analysis software.Two-sample t test and linear correlation analysis were used to analyze the data.Results The BW and SD of left ventricular in healthy subjects were (37.22 ±11.71)°,(11.84±5.39)° respectively.Comparisons between male and female for BW and SD yielded no statistical significance (BW:(36.00±9.70)°,(38.73±13.84)°; SD:(11.88±5.56)°,(11.79±5.26)°; t=0.96 and-0.07,both P＞0.05) ; whereas the older subjects (age≥60 years) had larger BW than the others (age＜60 years ; (39.95± 12.65) °,(34.33± 10.00) ° ; t =-2.11,P＜0.05) and no statistical significance was shown for SD between the two age groups ((11.18±4.31) °,(12.54±6.33) ° ; t =1.08,P＞0.05).Of the 74 subjects,the mechanical activation started from the ventricular base to apex in 54 subjects (73％),and from apex to base in only 20 subjects (27％).High repeatability of phase analysis was observed for both intra-observer and inter-observer (r=0.867-0.906,all P＜0.001).Conclusions Good left ventricular segmental synchrony is shown in healthy subjects.No gender difference exists for ventricular synchrony assessment.Age (＜60 years) is important for better synchrony.Cedars-Sinai QGS cardiac phase analysis software is valuable in quantitative assessment of left ventricular synchrony with high repeatability.

Objective To prepare monoclonal antibodies specific to lactate dehydrogenase of Plasmodiun falciparum. Methods The Plasmodium falciparum lactate dehydrogenase (pLDH) gene was amplified from whole blood of malaria patients by PCR and cloned into expression vector pGEX-3X. Recombinant pLDH protein was expressed and purified, and used for immunizing mice to prepare monoclonal antibodies (McAbs). The McAbs were characterized by Western blotting analysis. Results The Plasmodium falciparum lactate dehydrogenase gene was amplified and cloned into expression vector pGEX-3X. The recombinant pLDH plasmid was expressed in E.coli) BL-21 cells. 15 cell lines of McAbs with high titer against pLDH were obtained using the recombinant pLDH as immunogen. Western blotting analysis showed that these McAbs recognized a Mr 33 000 of native Plasmodiun falciparum protein without cross-reaction with constituents of red blood cell of febrile patients from endemic area of malaria. Conclusion Fifteen hybridoma cell lines secreting high titer of McAb specific to Plasmodium falciparum LDH were established based on the recombinant pLDH.

Objective To observe the influence of recombinant human brain natriuretic peptide(rhBNP)treatment on serum C-reactive protein(CRP)level in patients with congestive heart failure.Methods Forty patients with congestive heart failure(NYHA class Ⅳ)were divided into experimental group(n=20)receiving rhBNP and control group(n=20)receiving isosorbide dinitrate.Blood pressure and central venous pressure were observed and hypersensitive CRP was checked before and one week after treatment in both groups.Results No obvious change of blood pressure at each time point was found after BNP treatment(systolic blood pressure:P=0.804;diastolic blood pressure:P=0.492)while significant decrease of CVP was noted(P=0.016).Serum CRP level was significantly decreased one week after BNP treatment(10.1?7.4 mg/L vs 7.7?5.0 mg/L;P=0.013)in experimental group,obviously different from that in the control group(P=0.044).hsCRP change was positively related to CVP change(Pearson correlation:0.469,P=0.043).Conclusion Brain natriuretic peptide effectively decreases serum C-reactive protein level in the patients with congestive heart failure,indicating its possible role in relieving inflammation in heart failure.

OBJECTIVE To evaluate the relationships between antimicrobial usage and the isolated rate of ESBLs-KPN and ESBLs-ECO.METHODS We monitored the data on the yearly patient-days and the yearly consumption(defined daily dose(DDD) per 1000 patient days) frequent antibiotics and the isolated rate of ESBLs-KPN and ESBLs-ECO causing nosocomial infections from Jan 2004 to Dec 2007 was analyzed.RESULTS The yearly patient-days of our department significantly increased from 64 203 days in 2004 to 74 442 days in 2007(P