Objective To summarize clinical characteristics, diagnosis and surgery of abnormally origination of left coronary artery from the pulmonary artery. Methods Clinical data of 10 patients with left coronary artery abnormally originating from pulmonary artery were analyzed, including 5 men and 5 women, aged from 13 to 40 years. Definite diagnosis was made by ultrasonic cardiogram (UCG) and cardiac catheter examination. Three cases were simply abnormal origination, six cases combined with MI, and one case combined with both MI and ventricular aneurysm of left ventricular apex. Ligation of the abnormal coronary artery was done in four patients, three were given pulmonary artery inner tunnel plasty under extrocorporeal circulation. Open implantation of left coronary artery to ascending aorta were done in 3 patients, while plasty of mitral valve were performed in 5 and ventricular aneurysm resection in 1. Results One patient died postoperatively. The follow-up ranged from 1 month to 11 years. One patient received replacement of mitral valve 16 months after first surgery due to severe MI. All the followed-up patients presented no myocardial ischemia or infarction, no residual shunt or late death. Cardiac function was rehabilitated to grade 1. Conclusion Obvious blood dynamics and cardiovascular morphology changes existed in patients with left coronary artery abnormally originating from pulmonary artery. Early diagnosis and surgery should be done. Proper surgical approach is the key to success.

Treatment based on syndrome differentiation is an essential feature of traditional Chinese medical diagnosis. The interventions based on changes of syndrome types in randomized controlled trials are complicated, leading to the difficulty of blind method enforcement. This article described a double-blind method. It could be used in randomized controlled trials under the condition of different syndrome types and different medications. It numbered drugs in two stages, and in two phases to achieve double-blind. This method not only guaranteed investigators and subjects to be in blinded conditions, but also achieved using different medications for patients of different syndromes. It also caused no drug waste. It was scientific and feasible.
Double-Blind Method ; Humans ; Medicine, Chinese Traditional ; Randomized Controlled Trials as Topic ; Single-Blind Method

Objective To evaluate the use of three-dimensional reconstruction (3D) to improve the success rate in the first attempt of radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC).Methods A retrospective study was conducted on 109 patients with small HCC (with single nodule from 3 to 5 cm in diameter) treated with radiofrequency ablation between June 2010 and June 2013.A safe ablation margin was evaluated before and after radiofrequency ablation.The patients were divided into two groups: the 3D-RFA group (49 patients were evaluated by three-dimensional reconstruction before RFA treatment) and the 2D-RFA group (60 patients were not evaluated by three-dimensional reconstruction before RFA treatment).The success rate of the first attempt of radiofrequency ablation, recurrence free survival, overall survival and complications were compared between the two groups.Results The success rate of first ablation reached 95.9％ (47/49) in the 3D-RFA group which was significantly higher than the 48.3％ (29/60) in the 2D-RFA group (P ＜ 0.05).The local tumor progression rate was 8.1％ in the 3D-RFA group versus 23.3％ in the 2D-RFA group (P ＜0.05).The 1-, 2-, 3-year recurrence free survival rates were 85.4％, 63.9％, and 49.8％ respectively in the 3D-RFA group and 72.4％, 43％, and 34.4％ respectively in the 2D-RFA group (P ＜ 0.05).The 1-, 2-, 3-year overall survival rates were 91.4％,78.4％, and 60.9％ respectively in the 3D-RFA group and 83.3％, 58.7％, and 40.9％ respectively in the 2D-RFA group (P ＜0.05).Complications occurred significantly less in the 3D-RFA group (4％, 2/49) than the 2D-RFA group (13.3％, 8/60;P ＜ 0.05).Conclusion Three-dimensional reconstruction improved the success rate of the first attempt of radiofrequency ablation and the prognosis of patients, and with less complications for small hepatocellular carcinoma.

Objective To investigate plasma levels of high-sensitivity C-reactive protein (hs-CRP) in patients with coronary heart disease (CHD) and relationship between hs-CRP levels and cardiac function. Methods The serum hs-CRP concentrations in 894 CHD patients diagnosed by coronary angiography and 141 healthy controls were measured by particle enhanced immunoturbidimetric assay. Results The median of hs-CRP levels was 1.70 (0.13-19.53 ) mg/L and abnormal ratio was 37.6% (336/894), that were significantly higher in CHD group than healthy controls [0. 99(0. 13-19. 53) rag/L, 7. 1% (10/141) ] (Z=-6. 476,X<'2> = 50. 882, P <0.01 ). The median of hs-CRP levels was 5.35 (0. 18-19. 10) mg/L and abnormal ratio was 63.9% (92/144), that were much higher in acute myocardial infarction (AMI) group than in old myocardial infarction (OMI) group [2.27 (0.13-19.19) mg/L, 43.7% (129/295) ] (Z = -3.353 ,X<'2> = 15. 732, P <0. 01 ). The median of hs-CRP levels was 1.45 (0.19-19.53) mg/L in unstable angina pectoris(UAP) group and abnormal ratio was 29.1% (73/251), that were was higher in stable angina pectoris (SAP) group [1.04 (0.13-16.31 ) mg/L, 20. 6% (42/204) ] (Z=-2.981, P = 0.003;X<'2> = 4.30, P=0.038 ) . Furthermore, Kruskal-Wallis test showed the concentrations of hs-CRP and NT-proBNP was increased along with increment of CHD severity (NYHA functional classification) (X<'2> = 120.185,424.945, P <0.001 ). Multivariate analysis showed that hs-CRP levels positively correlated with NYHA functional classification ( r = 0.328, P <0.01 ) as well as NT-proBNP levels (r=0.413, P <0.01 ). Conclusion Serum hs-CRP level increases along with CHD severity, indicating that hs-CRP may play a certain role in the occurrence and development of CHD.

Objective To explore the immune effects of high intensity focused ultrasound (HIFU) in the treatment of pancreatic carcinoma and to investigate the imaging methods to evaluate HIFU's efficacy.Methods A total of 32 patients with pancreatic carcinoma treated by HIFU were enrolled.The freeze-thaw antigen was prepared by freezing and thawing the cancer cells.HIFU antigen was prepared by cancer cells sonicated by HIFU.The killing effects of no antigen activated dendritic cells (DC) induced T lymphocyte (DC-T),freeze-thaw antigen activated DC induced T lymphocyte (freeze-thaw antigen-DC-T) and HIFU activated DC induced T lymphocyte (HIFUantigen-DC-T) in autologous pancreatic cancer cells were detected by lactic dehydrogenase kit.The changes of immune indexes [heat shock protein 70 (HSP70),T helper lymphocyte Thl/Th2 and transforming growth factor-β (TGF-β)] before and after H IFU treatment were determined by enzymelinked immunosorbnent assay (ELISA) method.The changes of clinical efficacy indexes [visual analogue scale (VAS),performance status (PS) and carbohydrate antigen (CA) 19-9] before and after HIFU treatment were compared.The instant and recent (two months) efficacy of HIFU treatment were evaluated by contrast enhanced ultrasonograph (CEUS) and computed tomography (CT).The line q test was performed for comparision between groups.t-test was applied for comparision before and after treatment.Results Compared with freeze-thaw antigen,the killing effect of HIFU antigen-DC-T in autologous pancreatic cancer cells was higher (40.24％ ± 10.56％ vs 46.93％±13.26％,q=3.44,P＜0.05).HSP70 [(17.31±4.75) ng/mlvs (22.84±5.56) ng/ml],Th1/Th2 (1.24±0.36 vs 1.47±0.31),TGF-β [(1.39±0.41) ng/ml vs (1.04±0.38) ng/ml],VAS (3.97±1.32 vs 3.26±1.18),PS (2.76± 1.02 vs 2.21±0.86) and CA19-9 level[(135.39±37.45) U/ml vs (114.82±30.51) U/ml] improved after HIFU treatment compared with those before treatment (t=4.278,2.739,3.542,2.268,2.332 and 2.409,allP＜0.05).CEUS and CT showed that blood supply and the volume of the tumors reduced after HIFU treatment.Conclusions HIFU is effective in treating pancreatic carcinoma,improving immune status of patients and enhancing antitumor response.CEUS can real-time evaluate the efficacy of HIFU treatment.

Objective:To study the effect of total saponins on cerebral blood flow and vascular resistance in anesthetized dogs.Methods:Thirty hybrid dogs in either sex,with a body weight of(11?1.5)kg,were evenly randomized into 5 groups: negative control group(saline 5 ml/kg,ig),positive control(nimodipine 300?g/kg,iv),and 3 groups treated with total saponins (low-dose group[10 mg/kg,ig],middle-dose group[30 mg/kg,ig],and high-dose group[60 mg/kg,ig]).The dogs were anes- thetized with intravenous pentobarbital sodium(30 mg/kg).The right common carotid artery was exposed to measure the cere- bral blood flow,cerebral vascular resistance,blood pressure and heart rate using the MFV-3200 electromagnetic flow meter and MPA-3000 bioelectricity signal-amplifier.Results:Compared with negative control,cerebral blood flow was significantly in- creased in animals treated with asparagus root saponins(30 and 60 mg/kg,ig)during 5 and 120 min after drug administration (P

OBJECTIVETo study the correlation between arachidonic acid (AA) and acute red blood cells damage in rats, and to build a model with hidden blood loss in vivo, and to explore the pathological mechenism of hidden blood loss.

METHODSA total of 50 male adult Sprague-Dawley rats weighing (200 ± 20) g were randomly divided into five groups (n = 10): control group and four experimental groups. The rats in the experimental groups were given 0.5 ml different concentrations of AA dilu- ents, 5, 10, 20, 40 mmol/L respectively. The blood samples were collected from orbital venous at the beginning and 24, 48, 72 hours after administration. Then the changes of hemoglobin (Hb) ,red blood cell count (RBC), glutathione peroxidase (GSH- PX) activity, total superoxide dismutase (T-SOD) activity and hydrogen peroxide (H202) in the blood samples were tested.

RESULTSSignificant hidden blood loss occurred when the concentration was 10 mmol/L in the experimental group, with the RBC and Hb sharply reduced in blood samples. The Hb and RBC were reduced in all the experimental groups and control group at 24 hours after administration, while in the experimental groups they changed more obviously. The GSH-PX activity, T-SOD activity and H₂O₂were also significantly reduced in all groups, and the changes showed significant differences. The Hb and RBC were relatively stable in the control group and the experimental groups at 48 hours after administration; while GSH-PX activity, T-SOD activity and H₂O₂were all significantly decreased, and the changes in the experimental groups were more notable.

CONCLUSIONElevated levels of AA in the blood causes oxidative stress in the red blood cells, leading to the damage of red blood cells and hemoglobin, which is responsible for hidden blood loss.

Animals ; Arachidonic Acid ; toxicity ; Erythrocytes ; drug effects ; metabolism ; Glutathione Peroxidase ; blood ; Hemoglobins ; analysis ; Male ; Rats ; Rats, Sprague-Dawley ; Superoxide Dismutase ; blood

4-Hydroxycoumarins ; urine ; Animals ; Chromatography, High Pressure Liquid ; methods ; Sensitivity and Specificity

Objective To elucidate the immunologic mechanism and clinical effect of high intensity focused ultrasound (HIFU) combined with dendritic cell and cytokine induced killer cell (DC-CIK) immunotherapy on patients with pancreatic cancer.Methods Seventy-two pancreatic cancer patients were divided randomly into 2 equal groups,one treated with HIFU only the other treated with HIFU and DC-CIK immunotherapy.Ultrasound imaging and a variety of immunological indexes were recorded before and after treatment and the clinical effects in the two groups were compared.Moreover,autogenous tumor cells were isolated from the combination therapy group and the killing activity of DC-CIK which loaded tumor antigen processed by HIFU on autogenous tumor cells was observed.Results Tumor antigen processed by HIFU can improve the killing activity of DC-CIK on autogenous tumor cells.After treatment,the immunological indexes,of all patients were better than before treatment.(58.26 ± 17.97 versus 52.15 ± 14.22 pg/ml with IL-12 22.14 ± 6.39 versus 17.36 ± 5.73 ng/ml with HSP70 and 0.94 ± O.34 versus 1.32 ± O.61 ng/ml with TGF-β,P ＜ 0.05 ) ; The combination group was significantly better than the HIFU group with regard to the average scores of quality of life (75.89 ± 19.65 versus 67.22 ± 16.34,P＜0.05),pain (3.15 ±0.82 versus 3.59 ± 1.04,P ＜0.05),tumor markers (107.55 ±27.58 versus 123.63 ±34.12 U/ml) and survival time (18.92±6.47 versus 13.36 ±5.78 mos).Conclusion HIFU can improve the immunologic status and anti-tumor response in patients with pancreatic cancer.HIFU combined with DC-CIK has good synergistic therapeutic effect for treating pancreatic cancer.

Objective To compare the surgical outcome and long-term follow-up after mitral valve replacement through either minimally invasive(MI) or traditional median stemotomy(ST) surgery.Methods All 1 096 patients who received either MI or ST mitral valve replacement surgery,between January 1,2012 and July 30,2015 were analyzed for outcome differences due to surgical approach using propensity score matching(MI group n =405,ST group n =691).Find out the best matched with the 202 cases of the two groups.The clinical data of patients were collected including operativedata,postoperativecomplications,and follow-up.Results MI Group was longer in CPB time [(145.97 ±34.65)min vs.(92.24 ±25.58)min,(P ＜ 0.001)],aortic clamping time [(93.89 ± 25.25) min vs.(56.42 ± 18.09) min,(P ＜ 0.001)],and operating time[(237.49 ± 47.48) min vs.(217.31 ± 55.95) min,(P ＜ 0.001)].The MI group was associated with more less in transfusion(24.26％ vs 33.66％ P=0.037),mechanical ventilation[(15.29 ±11.45)h vs.(21.34 ±40.36)h,(P=0.041)],ICU stay[(44.12 ±39.51)h vs.(61.15 ± 106.01) h,(P =0.033)],volume of thoracic drainag[(404.11 ±485.84)ml vs.(674.82 ±585.37)ml,(P＜0.001)],postoperative drainage time[(2.59 ±1.75)d vs.(4.25 ±1.91)d,(P ＜0.001)],hospital stay [(5.64 ± 3.07) d vs.(1 1.44 ± 6.71) d,(P ＜ 0.001)].There were no significant difference in the complications of follow-up(P ＞ 0.05).SF-36 score had no significant difference either(P ＞ 0.05).Conclusion The minimally invasive thoracoseopic has longer in CBP time and cross-clamp time,;but it didnot increase the risk of mortality and complications.What's more,havingless trauma,fewer transfusions,lcss wound infection,faster rccovcry,and high satisfaction with the incision in long-term follow up and other advantages.Minimally invasive thoracoscopic cardiac surgery is safe,effective and feasible.