Objective:To explore dynamic change of heart rate variability (HRV) before and after circumferential pulmonary vein ablation (CPVA ) in patients with paroxysmal atrial fibrillation (PAF) and its relationship with postoperative recur‐rence .Methods:A total of 108 PAF patients undergoing left atrial circumferential pulmonary vein electrically isolated ra‐diofrequency ablation were selected .According to 12‐lead DCG on 3d and three months after operation ,patients were di‐vided into early recurrence group (n=10) ,late recurrence group (n=21) and no recurrence group (n=77) .HRV changes were followed up and compared among all groups .Results:Compared with before ablation ,on 3d after ablation ,there were significant reductions in standard deviation of normal to normal RR intervals calculated over the 24 h period (SDNN) , standard deviation of normal to normal RR intervals in all 5 min segments of the entire recording (SDANN) ,root‐mean square of differences betweensuccessive normal to normal intervals (rMSSD) ,low frequency (LF) ,high frequency (HF) in no recurrence group ;significant rise in mean heart rate ,and significant reductions in SDNN ,LF and LF/HF in early recur‐rence group ( P< 0.05 or <0.01);compared with no recurrence group ,there were significant rise in mean heart rate [(69.3 ± 11.2) beats/min vs .(75.4 ± 14.0) beats/min] ,SDANN[(66.9 ± 25.7)ms vs .(137.5 ± 92.3)ms] ,rMSSD [(22.1 ± 10.6)ms vs .(46.2 ± 19.2)ms] ,LF [(233.1 ± 31.4)ms vs .(251.7 ± 17.3)]and HF[(228.0 ± 82.4) ms2 vs . (508.0 ± 13.5) ms2 ] ,and significant reduction in LF/HF[(1.13 ± 0.53) ms2 vs .(0.41 ± 0.13) ms2 ]in early recurrence group (P<0.05 or < 0.01);significant rise in rMSSD [(23.9 ± 11.10) ms2 vs .(52.0 ± 28.7) ms2 ]and HF[(344.4 ± 103.2) ms2 vs .(482.1 ± 100.6) ms2 ] ,and significant reduction in LF/HF[(1.16 ± 0.41) vs .(0.85 ± 0.43)]in late recur‐rence group , P<0. 05 or <0. 01. Conclusion:Vagal tone reduction may reduce recurrence after CPVA in PAF patients .

The application of molecular biological technique provides opportunity to pancreatic cancer patients since the cancer is resistant to routine treatment. Clarifying the molecular mechanism in the genesis and development of pancreatic cancer is the first thing to do. Recent researches found that there were different signaling pathways activated in different stages of pancreatic cancer. The important signal pathways included mitosis pathways, growth factor pathways, developing pathways and mucin pathways. This article will review the relationship between molecular pathways and pancreatic cancer.

Oral fluid resuscitation in early period of hypovolemic shock is an important measure in the treatment of casualties in the battlefield as well as in mass casualties in lieu of the means of establishing a venous line. The main tasks in the study of oral rehydration resuscitation are the proposition of appropriate prescriptions of the liquids to be given and methods of administration on the basis of a clear elucidation of the mechanism underlying the function of the digestive system in regard to transportation and absorption of the given ingredients. The aim of the study is to fully replenish maximal amount of fluid containing glucose and electrolytes in a convenient, expeditious, and effective way in a minimal span of time, in order to increase circulating blood volume. At the same time, ischemia and tolerance to oral fluids of the gastro-intestinal tract should be improved, electrolyte imbalance and incidence of secondary infection should be alleviated, and finally hypovolemic shock is corrected, so that the victim is kept alive and prepared for further definitive surgical intervention.

Objective To investigate the causer of, and the way to deal with the measurement of protecting from vascular compromise in free flap transplantation. Methods To retrospectively study the clinical data collected from the 89th Hospital of PLA including 305 cases of vascular compromise in free flap transplantation held on June, 1983 to December, 2006. Accoding to the different tissue flaps and different sites to be repaired, 11 factors of vascular compromise of free flap transplantation were to be investigated including operation design, the recipe of free flap, the variation of vascellum, the skill of recipe, the operation opportunity, the match of vascellum, the debride of vascellum, the vascellum angiotasis, the vascular anastomosis, the management of vascular articulo and the infection. Results Among the 305 cases of free flap transplantation, arterial compromise existed in 270 cases, 10 cases developed arterial compromise during operation, 6 cases were due to the injury of nutrient vessel, the flap survived after the revascularization. 4 cases obtained part necrosis of 10 cases, and the rotation flap and skingrafting covered the raw surface. The rest 213 cases survived and 47 cased failed. Another 35 cases of vein compromise were obtained. Among them, 5 cases survived, part necrosis of 10 cases, and 20 cases failed. Conclusion Vascular compromise is the factor of necrosis in free flap transplantation. It is of cardinal importance to timely and correctly treat the vascular compromise in free flap transplantation whether happened intra-or postoperatively. This is the key to access high successful rate. Preventive measures are even more beneficial than proper management after its occurrence. The venous return disorder was the main factor of free flap transplantation failure.

Objective:To investigate the effects of enteral nutrition assisted therapy in preventing postoperative anastomotic fistula in patients with esophageal cancer and its influence on immunity,healing process and nutritional recovery.Methods: The clinical data of 90 cases of patients with esophageal cancer who underwent surgical treatment were retrospectively analyzed.According to the mode of postoperative nutritional support,the patients were divided into group A(n=34),B(n=30)and C(n=26)three groups.Group A was treated by immune-enhancing enteral nutrition(Supportan)assisted therapy.Group B was treated with routine enternal nutrition(Nutrison Fibre)assisted therapy.Both of the two groups were treated with 25%,50% and 100% of the full dose on the 1st,2nd and 3rd-7th day after surgery.Later,the dose was reduced day by day till normal diet.Group C was treated by parenteral nutrition assisted therapy.Since the 1st day after surgery,patients in group C were intravenously injected with glucose,vita min and a mino acid mixed liquid calculated by 125.52 kJ/kg.8-10 d later,patients gradually transited to the normal diet.The incidence rates of anastomotic fistula,pulmonary infection and incision infection,wound healing time,total hospitalization time and initial exhaust time were observed and compared between the three groups.The changes of immune index [T lymphocytes and its subsets(CD3+,CD4+,CD8+)],inflammatory factors[C reactive protein(CRP),IL-6]and nutrition indexes[serum total protein(TP),albumin(ALB)]before surgery,on the 1st and 8th day after surgery were recorded.Results: ①There were significant differences in the incidence rates of postoperative anastomotic fistula and pulmonary infection between the three groups(P<0.05),and the incidence rates in group C were significantly higher than those in the other two groups(P<0.05).②There were significant differences in wound healing time,total hospitalization time and initial exhaust time between the three groups(P<0.05)and that of group C group was longer than that of the other two groups(P<0.05).③On the 1st day after surgery,the levels of immune indexes such as CD3+,CD4+,CD4+/CD8+ and nutrition indexes such as TP and ALB in the three groups were significantly lower than those before surgery.CD8+ levels and levels of inflammatory indexes such as CRP and IL-6 were significantly higher than those before surgery(P<0.05).However,there was no significant difference between the groups(P>0.05).On the 8th day after surgery,the nutrition indexes in the three groups were still significantly lower than those before surgery.However,those in group A and B were significantly higher than those in group C(P<0.05);the inflammatory factors were still significantly higher than those before surgery(P<0.05)but those in group A and B were significantly lower than those in group C(P<0.05).Among the three groups,there was no statistical significance in comparing the immune indexes with those in group A(P>0.05).The levels of CD3+,CD4+,CD4+/CD8+ in the other two groups were lower than those before surgery while CD8+ level was higher than that before surgery(P<0.05).Conclusion: To apply enteral nutrition assisted therapy in patients with esophageal cancer after surgery can effectively improve the prognosis.It has positive effects on shortening the healing process,improving the immune function and improving the nutritional status.

Objective To investigate the effect to the blood supply of the gastrocnemius if ligating the medial or lateral artery, and provide theory base for the sural artery flap repairing the soft tissue defects of legs injuries.Methods The anatomical study involved 16 fresh adult cadaver lower legs ligating the medial or lateral gastrocnemius vessel, the arteries of which were perfused with the Meglumine Diatrizoatis Mucilage,and then carried out the cross-sectional analysis of the CTA, the bifurcation, location length, diameter and perforator of the sural artery were recorded by dissection.To observe the anastomosis with gastrocnemius vessel in artery pipeline foundry made by 1 specimen.Results The consistent with the result of the angiography was the gastrocnemius can completely get enough blood supply from some anastomotic arteriole when ligating one side of the sural vessel.Under normal circumstances, the blood supply of gastrocnemius muscle mainly supplied by sural artery.In the case of the sural vessel was cut off, the blood supply of gastrocnemius come from the anastomotic arteriole between medial and lateral artery and the soleus.The anastomotic arteriole from soleus has larger diameter, but less quantity, and was invariably deteced in the lower third of the gastrocnemius muscle constantly.A lot of anastomotic arteriole were found between the muscle heads, and it was also invariably deteced in the lower third of the gastrocnemius muscle, communicating with the surai neurovascular axis, the average external diameter was less than 0.5 mm.Conclusion The blood supply of the gastrocnemius are enough when ligating the medial or lateral artery.

Objective To evaluate clinical application of the gastrocnemius blood vessles as recevier ones to anastomose with free flaps. Methods From June 2005 to July 2011,twenty adult lower limbs were infused with red glue to observe the origin,streching,branches and communication with other blood vessles of the gastrocnemius blood vessles and to measure their outer diameters and pedicle length. Operations were also simulated on these specimens to make the above chacracters of the vessles clear further.CT images of 16 fresh adult lower limbs were got to observe the effects of obstruction of one side of the gastrocnemius blood vessels to the blood supply of the gastrocnemius muscles. Fifty-two free flaps were transplanted to legs with large defects of skin and soft tissues where the gastrocnemius blood vessles were anastomosed with the flaps to supply artery blood and receive vein blood. Results The main blood vessles of the gastrocnemius muscles were medial and lateral gastrocnemius blood vessles. They both origined from the popliteal arteries and communicated with other blood vessles. The pedicles of the medial gastrocnemius blood vessles were 8.0 -13.8 cm in length which averaged 11.1 cm and their outer diameters were (1.8 ± 0.3) mm when they entered the muscles. The pedicles of the medial gastrocnemius blood vessles were 5.4 - 12.3 cm in length which averaged 8.8 cm.The outer diameters of the two accompanying veins were (1.8 ± 0.3)mm when they entered the muscles.When one gastrocnemius blood vessle were obstructed,the gastrocnemius muscles could got enough blood supply by co mmunicating branches between the obstructed vessle and other blood vessles.All the 52 free flaps survived. Through one to two-years follow-up, the defects cured with no infection and the knees' motions were normal. Conclusions With a long pedicle and wide diameter,the medial or lateral gastrocnemius blood vessle can be a reliable alternative used in free flap transplautation for repairing large defects of skin and soft tissues of seriously injured legs with no other choice of blood vessles, which causes unobvious effects to the blood supply of the legs and can simplify the free flap transplantation.

Objective To assess the rotational set-up errors in patients with thoracic neoplasms. Methods 224 kilovohage cone-beam computed tomography (KVCBCT) scans from 20 thoracic tumor pa-tients were evaluated retrospectively. All these patients were involved in the research of " Evaluation of the residual set-up error for online kilovohage cone-beam CT guided thoracic tumor radiation". Rotational set-up errors, including pitch, roll and yaw, were calculated by 'aligning the KVCBCT with the planning CT, using the semi-automatic alignment method. Results The average rotational set-up errors were -0.28°±1.52°, 0.21°± 0.91° and 0.27°± 0. 78° in the left-fight, superior-inferior and anterior-posterior axis, respective-ly. The maximal rotational errors of pitch, roll and yaw were 3.5°, 2.7° and 2.2°, respectively. After cor-rection for translational set-up errors, no statistically significant changes in rotational error were observed. Conclusions The rotational set-up errors in patients with thoracic neoplasms were all small in magnitude. Rotational errors may not change after the correction for translational set-up errors alone, which should be e-valuated in a larger sample future.

BACKGROUND: Enophthalmos deformity is the most common complication caused by orbital blow-out fractures, and others are diplopia and worsening of visual acuity. Since the therapeutic result of orbital blow-out is not satisfactory and many complications exist after operation, it is still a dispute to select implantation materials and therapeutic regimens.OBJECTIVE: To observe the therapeutic effect and assess the improvement of visual function by surgical reconstruction with porous high-density polyethylene (Medpor) for the correction of enophthalmos deformity caused by orbital blow-out fractures.DESIGN: A pre-and postoperative controlled study.SETTING: Beauty Center for Trauma Repair,Plastic Surgery Hospital,Peking Union Medical College, Chinese Academy of Medical Science .PARTICIPANTS: Totally 56 patients with orbital blow-out fractures who had enophthalmos deformity caused by fists or traffic accidents, treated at Beauty Center for Trauma Repair,Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, were selected in this study from December 1996 to March 2004. Final diagnosis were made with case history, X-ray film, two-demensional and three-dimensional CT before operation. 24 cases were accompanied with other areas fractures such as zygoma and nasal bone, 34 cases with diplopia, 35 cases with visual acuity worsening after injured.METHODS: ①Material implantation: Exposure of the orbital floor, inferior and medial walls could be performed through a 2 mm inferior subciliary incision of 3 cm long. To approach the orbital rim via a dissection plane anterior to the orbital septum, sub-periosteal dissection was then performed over the orbital rim, and along the orbital floor to the orbital apex. Mobilized the soft tissue from the bone throughout the entire area of fractures and re-position it to its proper position. Took Medpor (Type 6331) sheets as the implantation materials, trimmed Medpor sheets according to the radian and anatomic form, and 2 mm larger than the defect rim was needed.If other operations were needed during the operation, they could be done.Mannitol and dexamethasone should be used just postoperatively to decrease edema of the orbital contents and reduce inner orbital excessive pressure. ②Functional evaluation standard: Diplopia: completely disappear meant recovered, less diplopia residual meant improvement, no improvement meant inefficacy. Enophthalmos: marked improvement meant the degree of enophthalmos stabilizated at below 2 mm, less improvement meant stabilizated at above 2 mm.MAIN OUTCOME MEASURES: ①Improvement of enophthalmos; ②Improvement of diplopia ; ③Improvement of visual acuity.RESULTS: ①All 56 cases of enophthalmos deformities caused by orbital blow-out fractures improved greatly. ② Of all the 34 patients with diplopia, 27 recovered. ③ 9 patients' visual acuity of 35 improved with different degrees. No diplopia or visual acuity worsening occurred. With a follow-up ranging from 2 months to 5 years, the degree of enophthalmos stabilizated at below 2 mm, and no relapse and other complications occurred.CONCLUTION: Medpor has such advantages as better histocompatibility,fewer complications and better visual function improvement, so it is the preferred implantation material for correcting enophthalmos deformity caused by orbital blow-out fractures.

Objective:To report the preliminary results of intensity modulated radiation therapy(IMRT)for 20 nasopharyngeal carcinoma patients.Methods:A total of 20 patients with nasopharyngeal carcinoma received IMRT in our hospital between January 2007 and April 2008.Five patients were of stage Ⅱ,13 patients were of stage Ⅲ,and 2 patients were of stage Ⅳ.The prescribed dose 69.96 Gy was delivered to the gross tumor volume(PTV)and positive neck nodes(PTVnd);59.36 Gy to the clinical target volume(PTV1),covering the upper neck and area around the nasopharynx;and 50.96 Gy to the low neck and supreclavicular area (PTV2).The dose to 50% of the parotid was≤35 Gy.The maximum dose to the lens.pituitary gland,temporo-mandibular joint,mandible,and temporal lobe was 9,54,60,70,and 60 Gy.The maximum dose to the brainstem,spinal cord,optic nerve and optic chiasma(PRV)was 54,40,54,and 54 Gy,respectively.All of the patients received 1 or 2 circles of chemothrapy before IMRT.Results:The median follow-up time was 14 months.The one-year overall survival was 94.1%.One patient died of osseous metastasis and respiratory failure and 3 patients developed distant metastasis.Acute toxicity was mostly Grade Ⅰ to Grade Ⅱ.Seventeen patients had grade Ⅰ xerostomia.Three patients suffered from grade Ⅰ acute oral mucosa reaction and 12 patients had grade Ⅱ acute oral mucosa reaction.Analysis of the dose-volume histograms (DVHs) showed that the mean dose delivered to the PTV,PTVnd,PTV1 and PTV2 was 73.4,74.1,67.8,and 54.1 Gy,respectively.The median dose to 50% of the right and left parotid glands was 43.9 Gy and 41.9 Gy,respcetively.The average value of maximum dose to the left and right lens was 8.06 and 8.12 Gy,respectively.The average value of maximum dose to the brainstem,spinal cord,left and right optic nerve and optic chiasma PRV was 60.6,46.6,50.0,55.0,and 56.0 Gy,respectively.Conclusion:IMRT can achieve satisfactory dose distdbution to nasopharyngeal carcinoma and surrounding tissues in NPC patients,protect normal tissues during the treatment and improve local control rate.