Objective To investigate the clinical values of dexmedetomidine in general anesthetic for laparo-scopic cholecystectomy.Methods One hundred patients admitted to our center with cholelithes were prospectively studied.According to the principle of completely random digital table,all patients were randomly signed to dexmedeto-midine group or control group.The primary outcomes were hemodynamic changes and postoperative complications. Results There was no significant differences at t0,t1,t2,t3,t4 and t5 in mean arterial pressure (P >0.05).There was no significant difference in heart rate at t0 (P =0.503),however,compared with the control group,patients in the dexmedetomidine group got a significant reduction in t1,t2,t3,t4 and t5 in heart rate(all P <0.05).Compared with the control group,the operation time of the dexmedetomidine group was significantly shorten[(1 18.52 ±15.42)min vs.(127.24 ±19.14)min,t = -5.673,P =0.021 ],the rate of movement of the center of the operation was significantly decreased (36% vs.64%,χ2 =7.840,P <0.001),the incidence rate decreased significantly (0% vs. 10%,χ2 =5.263,P =0.022).There was no difference between the two groups in intra -operative bleeding volume, hypertension,hypotension,tachycardia,postoperative drainage volume,postoperative bleeding,infection and vomiting (all P >0.05 ).Conclusion Dexmedetomidine contributed to maintaining the hemodynamic stable in general anesthetic for laparoscopic cholecystectomy,and reducing the rate of shivering.

Ostial lesions present many challenges for percutaneous coronary intervention (PCI). Coronary anomaly will further increase difficulties in performing PCI for the patient. We present such a case as ostial occlusion of an right coronary artery with high takeoff. A 77-year-old male was referred to our institution with a diagnosis of non-ST elevated acute myocardial infarction. Selective coronary angiography and nonselective ascending aortography could not identify the origin of the right coronary artery. Multi-slices computed tomography showed RCA ostial totally occluded. A successful PCI was performed and a perfect final result was achieved utilized with many tips and tricks, including buddy wire technique and focused-force angioplasty.

Cardiac biomarkers of sensitive and specific are very important to the early diagnosis of cardiovascular diseases,such as cardiac troponin (high sensitivity),myoglobin,heart-fatty acid-binding protein,ischemia modified albumin,B-type natriuretic peptide and N-terminal-pro-B-type natriuretic peptide.They also play an important role in risk stratification and prognosis evaluation,but improvement is still needed.Biomarker of high sensitivity and specificity,convenient detection control is still required in clinical application.

During the last fifty-year medical treatments have made great advances in the treatment of heart failure(HF).The current applicatin of treatment improves the life quality of patients with HF,and reduces their clinical envents and mortality.But the patients with refractory heart failure(RHF) have poor prognosis.This article reviews and analyzes the advances in the therapies for patients with RHF.

Objective: To establish a method for the determination of norcantharidin in norcantharidin in situ gel .Methods:An optimal HPLC method was set up and an Agilent ZORBAX SB-C18 column (150 mm ×4.6 mm, 5μm) was adopted.The mobile phase was acetonitrile-phosphate buffer solution(1∶9, adjusting pH to 3.1 with phosphorjc acid).The flow rate was 0.8 ml· min-1 and the column temperature was 25℃.The detection wavelength was set at 210 nm and the injection volume was 20μl.Results:Norcanthari-din had a good linear relationship within the range of 0.02-1.00 mg· ml-1 (r=0.999 9).The average recovery was 97.5%and RSD was 0.98%(n=9).Conclusion:The method is accurate, simple and reproducible, which can be used for the determination of nor-cantharidin in norcantharidin in situ gel .

The effect of the selective debridement with the aid of the arthroscope performed under local anesthesia for osfeoarthritis of 296 knees in 260 patients was studied. The pathological changes of osteoarthritis under the arthroscopy include hyperplasia of synovial membrane, degeneration of cartilage or exposure of subchondral bone on the stress areas of the femur condyles and patella , wear and tear of meniscus, formation of osteophyte and loose body. The debridement included the removal of the loose body, hyperplasia of synovial membrane, degenerated cartilage, and the torn meniscus. Many factors,including age of the patients, selection of the indication, stress of the knee joint, and the degeneration of cartilage,may influence the curative effect. After selecfive debridement and lavage for osteoarthritis of the knee joint, the majority of patients were released from pain, with restoration of function and range of motion, and the development of pathological process was retarded. Good and excellent results constitute 74.7% of the patients.

[Objective]To explore the clinical effects of selecting differents type of tendon transplants to reconstruct anterior cruciate ligament(ACL) using press fit technique.[Method]A total of 101 cases of ACL injury were included in this study,62 cases were athletic injuries,22 cases were traffic injuries,and 17 cases were daily-life injuries.According to patient's condition using different types of tendon transplant in which hamstring-tendon-knot 42 cases,bone-bolt-hamstring tendon knot 32 cases,patella bone-quadriceps tendon 27 cases,the tendon-knot was completely fit-into the bottle-necked femoral tunnel,and the tibial tunnel were pulled ont and seperated into two bundles, then tie a knot to fix the tendons tightly onto the bone bridge.[Result]In this group 98 patients were followed-up,According to the knee joint effective evaluate standard,88 were excellent,6 good and 4 fine.Excellent and good rate was 85.7%.[Conclusion]According to patient's condition,different type of tendon transplant to reconstruct ACL by press fit technique should be selected carefully.It is an method of easy to manipulate,reliable fixation,minimized trauma,biological fixation,economical and free expensive implant technique.

Objective To investigate the outcomes of arthroscopically lateral retinaculum patellae release and medial patellofemoral ligament reconstruction using the semitendinosus tendon autograft for the treatment of habitual or recurrent dislocation of the patella. Methods 18 cases of recurrent dislocation of the patella were included in this group, among which there were 6 males and 12 females. The average age was 20 years old(range from 17 to 24 years). Arthroscopic investigation found tensed lateral retinaculum patellae and damaged cartilage at patellar medial margin and femoral lateral condyle. There were 6 cases of Ⅱdegree cartilage injuries, 5 cases of Ⅲ degrees injuries, and 7 cases of Ⅳ degree injuries caused by patellofemoral joint impact. For cases of Ⅳ degree injuries, the damaged cartilage was shaved and microfractured. For cases of Ⅱ or Ⅲ degree injuries, radiofrequency system was used for debridement. After the lateral retinaculum patellae was extensively released, semitendinosus tendon autograft was used to reconstruct the medial patellofemoral ligament. The knee joint was flexed and extended. Patella's dynamic motion, the tension of the tendon and relationship between the femoral trochlea and patellar bone were arthroscopically observed. Interface screw was used to fix the tendon ends within the bone tunnel on condylus medialis femoris. Results All patients were followed up for 9 to 19 months averaging 13 months. No patellar dislocation occurred postoperatively. Apprehensive test, patella tilt test were negative; and Apley test were negative in 16 patients and positive in 2 patients. One case of inferior pole of patella fractured. Axial view of X-ray and MR images of patella showed 15 cases regained normal anatomical relation of patellofemoral joint. 3 cases had mild semi-dislocation. Lysholm's score averaging (78.0?4.5) points preoperatively and (94.0?3.5) points postoperatively. Conclusion Lateral retinaculum patellae solution and medial part reconstruction under arthroscope can effectively cure recurrent subluxation of the patella and improve knee joint function.

Objective We sought to determine the incidence,clinical features,and risk factors for retroperitoneal hematoma(RPH)after percutaneous coronary intervention(PCI).Methods A retrospective analysis yielded 21 cases of RPH out of 3,729 consecutive patients undergoing PCI between January 2000 and September 2005 in Anzhen hospital.Cases were compared with a randomly selected sample of 30 control subjects without RPH.Predictors were studied using univariate and multivariate analysis.Results The incidence of RPH was 0.6%.Anemia(100%)was a most universal feature.Features of RPH included hypotension(95%),diaphoresis(57%),groin pain(48%),abdominal pain(38%)and back pain(38%).The following variables were found to be independent predictors of RPH:female gender(odds ratio OR=5.23,P

As the indexes of reflecting whole blood coagulation and fibrinolytic capacity, thrombelas-tography are being increasingly used in the fields of guiding intraoperative blood transfusion, hypercoagulable state monitoring and correction, treatment of trauma patients, and clotting mechanism research. This article reviews the clinical application value and limitation of thrombelastography in patients with ischemic cerebrovascular disease.