Objective To review the strategies for multiple coronary artery bypass in patients with calcified ascending aorta.Methods From June 2002 to December 2007,36 patients with multiple coronary artery disease and calcified ascending aorta underwent OPCAB without aortic side-bite clamping.The patients(28 males and 8 females) aged from 60 to 83 years with a mean of(69.1?6.7) years.Fifteen of the patients had a history of stroke.Coronary angiogram revealed that 3 patients had double vessels disease and the others had triple vessels disease,involving the left main stem in 14 cases.The left ventricular ejection fraction ranged from 0.32-0.69.Calcified ascending aortic plaque can be explored in 30 of the patients during operation while intra-operative transesophageal echocardiography indicated calcified aorta only in 28.No-touch technique was used in 22 patients either with LIMA as the only inflow and the saphenous vein grafts was anastomosed to the LIMA in 15 patients,or with bilateral internal mammary arteries as the only inflows in 7 patients.Proximal anastomotic device was employed in 14 patients to finish the proximal anastomosis of greater saphenous vein grafts without aortic side-biting clamping.Intra-operative graft flow meter was used to check the flow of grafts before chest closure. Results Totally 116 cases of distal anastomosis were performed in the 36 patients(2-5 in each,mean 3.2?0.9).The patients woke up from anesthesia in 2 to 22 hours.Intraoperative measuring of graft flow revealed satisfying blood flow in all the grafts.In the 15 patients with LIMA as the only inflow,the total graft flow in the main stem of LIMA was basically the sum of each connected grafts.Only one patient died after surgery,showing a mortality rate of 2.7%.Eight patients(26.7%) had transient atrial fibrillation after the operation,2 showed pulmonary infection,4 had chest fluid,1 showed infection of the incision at the lower limb.All the complications were cured.30 patients achieved a 6-to 60-month follow-up with a mean of(33.8?11.2) months.During the period,11 patients(37 grafts) were examined by angiography,which showed that all the grafts of LIMA to LAD and vein grafts were patent,except in two vein grafts,which were occluded in the diagnol branches. Conclusions In patients with remarkable ascending aortic calcification,OPCAB combined with aorta no-touch technique or proximal anastomosis device can effectively decrease the incidence of postoperative stroke.

Objective To investigate the effects and the mechanism of Danshen dripping pill(DSP,复方丹参滴丸) on the lipid metabolism in rats under insulin resistant(IR) status.Methods Twenty-four Sprague-Dawley(SD) rats were randomly divided into normal control(n=8),IR control(n=8) and DSP groups(n=8).The rats were given dexamethasone(1 mg/kg) intramuscular injection once every other day to induce the IR status in the latter two groups,and the rats in DSP group were administered intra-gastrically with DSP 0.5 g/kg dissolved in normal saline once a day in the morning at 9 o′clock,and in the mean time,the rats in the normal and IR control groups were given intra-gastrically with equal amount of 0.9% NaCl. After 8 weeks of treatment,fasting blood glucose(FBG),fasting insulin(FINS),total cholesterol(TC),triglyceride(TG),nitric oxide synthase(NOS),nitrogen monoxidum(NO),smooth muscle depth/wall thickness of thoracic aorta were detected,and serum adiponectin concentration was measured by enzyme linked immunosorbent assay(ELISA),respectively.Results After IR model was successfully established,the insulin resistance index(HOMA-IR),TC and TG were increased,the serum NOS production and NO were decreased, smooth muscle depth/wall thickness of thoracic aorta was increased significantly,and the secretion of adiponectin concentration was decreased(P

By equality in the healthcare retorm we mean equal access to healthcare protection.Future reiorm should establish a fair value concept and make great efforts to solve the serious lack of fairness in the current healthcare system.Efficiency in the healthcare refers to not only higher revenue income of medical institutes but also to utmostly meet the citizens" needs for medical service.For the sake of the most cost - effective distribution of the insufficient budgets and medical resources,medical services have to be diversified for an improved efficiency. In the framework of the healthcare reform,relations between equality and efficiency is the unity of opposites,and top priority shall be given to equality while maintain efficiency.

Objective To sum up the imaging features of tuberous sclerosis.Methods CT and MRI findings of brain in 20 patients with tuberous sclerosis proved by clinic,imaging or pathology were retrospectively studied. Results Among 20 cases,on CT,the lesions appeared as subependymal calcified noduli in 16 cases (multiple noduli in 14 cases and single nodule in 2) and subependymal uncalcified noduli in 2,the noduli were 2~12 mm in diameter,2 cases were normal.On MRI,the subependymal noduli were multiple in 19 cases and single in one case,the noduli were iso-or hypointensity on T1WI and iso-,hypo or hyperintensity on T2WI.In addition,the lesions within cortical or sub-cortical matter were demonstrated by MRI in 19 cases,and the abnormal signals were showed in local patterns of cortical tubers.The abnormal findings of white matter were radial linear or wedge-shaped or irregular type in 7 cases.The subependymal noduli were enhanced,and the most of cortical lesions were not enhanced after contrast-enhanced MR scans in 9 cases.Conclusion There are characteristic findings of tuberous sclerosis both on CT and MRI.

AIM:We investigated the effects of Danshen Dripping Pill(DSP) on the glucose metabolism in rats during the insulin resistant(IR) statue. METHODS:HOMA-IR was used to show the degree of insulin resistant and Sprague-Dawley rats were randomly divided into 5 groups,normal control,IR control,Pioglitazone(PIO),Danse Injection(DSZ) and DSP groups,and the model rats were given dexamethasone to induce the insulin resistant statue.After being treated for 8 weeks,the serum adiponectin concentration and the relative expression amount of Glut-4 mRNA in skeletal muscles were detected by ELISA and real time PCR,respectively. RESULTS:The insulin resistant model rats induced by dexamethasone had a series of characters with the high level of HOMA-IR,and the serum adiponectin concentration was decreased,the Glut-4 mRNA relative expression amount in skeletal muscle cell and its translocation on the plasma membrane were inhibited.The effects of dexamethasone were significantly reversed by PIO,DSZ and DSP,respectively(P

Objective To analyze the correlation between gross motor function and activities of daily living(ADL)in children with cerebral palsy.Methods 42 children with CP(26 males,16 females,average age 49.5±21.5 months,11 children with spastic quadriplegia,22 with spastic diplegia,5 with spastic hemiplegia,2 with athetosis and 2 with dystonia)were assessed with Gross Motor Function Classification System(GMFCS)and Gross Motor Function Measure(GMFM)for the assessment and classification of gross motor function.Pediatric Evaluation of Disability Inventory(PEDI)was used to assess the ADL.The ADL of children with different levels of GMFCS and the correlation between gross motor function and ADL were analyzed.Results The more severe of GMFCS,the less standard score of PEDI.There was the highest correlation between the GMFM66 scores and scaled scores of PEDI in mobility and social function(r=0.84),whereas a weaker correlation appeared between GMFM66 scores and scaled scores of PEDI in social function(r=0.72).Conclusion Since the gross motor function of children with CP greatly affects the ADL,the gross motor function training should be the main item for CP children,the training goal of ADL should be made according to the levels of GMFCS.

Objective To investigate whether antisense integrin αV and β3 gene therapy has antitumor activity for hepatocellular carcinoma.Methods In this study,120 male nude mice at the age of 4 weeks old were devided into 4 groups randomly.The antisense integrin αV and β3 expression vectors were iniected into HepG2 hepatomas established in nude mice to monitor tumor growth after 6 weeks.Tumot inhibit rate was calculated.Tunor microvessel density(MVD)was determined by immunohistochemical staining,and tumor apoptosis by TUNEL. Results The tumor weight of the control group,αV group,β3 group and αVβ3 group was(1.38±0.92)g、(1.28±0.27)g、(1.30±0.34)g、(1.08±0.16)g respectively.The difference between each two groups was significant(q12=4.76,q13=3.73,q14=14.28,P＜0.05);The MVD was(17.53±1.88)、(16.06±1.92)、(15.83±2.00)、(14.86±1.69)respectively,(q12=3.91,q13=4.55,q14=7.13,P＜0.01);The AI of the control group,αV group,β3 group and αVβ3 group was 10.53%±3.29%,19.80%±4.06%,21.93%±3.26%,24.03%±4.45%respectively,with the difference being significant among groups(q12=29.41,q13=33.52,q14=39.7,P＜0.01).Conclusions Antisense gene therapy targeting αV and β3 integrins exerts dramatic inhibition on the growth of the tumor.

Objective To analyze the correlation between Doppler ultrasound parameters, blood biochemical indexes and the severity of esophageal varices (EV), and to explore the values of them in the diagnosis of severe EV.Methods A total of 102 hospitalized patients with liver cirrhosis was consecutively collected.All patients underwent endoscopic examination to determine the presence and severity of EV, then they were divided into moderate/severe EV group (n=78) and non/mild EV group (n=24).Congestion index of the portal vein (PV-CI), damping index of hepatic vein(HV-DI), hepatic vein arrival time(HVAT) and intrahepatic circulatory time (IHCT) were measured by Doppler ultrasound and contrast-enhanced ultrasound.And at same time, the level of yon Willebrand factor antigen (vWF-Ag) and soluble CD163 (sCD163) in peripheral blood were detected by enzyme linked immunosorbent assay (ELISA) method.The differences of these parameters between two groups were compared by independent samples t-test or Mann-Whitney rank sum test.The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of related parameters in the prediction of EV were calculated according to receiver operating characteristic(ROC) curve.Results Ultrasound parameters PV-CI, HV-DI and peripheral blood vWF-Ag, sCD163 levels of moderate/severe EV group were all significantly higher than those of none/mild EV group 0.11 (0.05) cm · s vs 0.07(0.03) cm· s;0.72±0.11 vs0.52±0.12;1 824.00(558.00) U/Lvs 1 533.80(311.50) U/L;(72.57±10.94) μg/L vs (57.91±10.40) μg/L;Z=-4.949, t=-7.759, Z=-5.420, t=-5.804, all P＜0.05).However HVAT and IHCT were significantly shorter than those of non/mild EV group (17.00(4.25) s vs 27.78(6.75) s;(6.62±1.85) s vs (9.33±2.26) s, Z=-3.822, t=5.820, both P＜0.05).ROC curve analysis showed that the areas under the ROC curve of HVDI, vWF-Ag and sCD163 predicting moderate/severe EV were all more than 0.8, the appropriate cutoff value of HV-DI, vWF-Ag and sCD163 was 0.64, 1 693.8 U/L and 63.98 μg/L, respectively.The sensitivity were all more than 75％,PPV were all greater than 90％ and DA were all more than 80％.Conclusion HV-DI, peripheral blood vWF-Ag and sCD163 levels can be taken as noninvasive parameters, which can effectively predict the presence of severe EV, facilitate early detection of these high-risk bleeding patients and prevent bleeding.

Objective To summarize imaging appearances of brain in AIDS patients,as to supply the evidences of imaging diagnosis for this disease . Methods CT or/and MRI appearances of brain in 19 patients with AIDS of nervous system type were reviewed . Results 3 cases showed the symmetry signal abnormal in bilateral whiter matter and 2 cases showed brain atrophy in 5 patients with HIV encephalitis.2 cases of toxoplasma encephalitis appeared multiple abnormal density or/and signal intensity in the brain and multiple ring enhancement . 3 patients with lymphoma displayed single or multiple nodule in the brain and nodular-enhancement or inhomogenous enhancement.3 patients with brain infarction displayed lower density in the basal ganglia on CT.2 patients with progressive multifocal leukoencephalopathy displaied multiple patch abnormal signal intensity of the white matter in frontal and parietal lobus.1 patient with cryptococcal infection showed abnormal signal and ring enhancement of the pons.1 patient with cryptococcal meningitis and 2 patients with intracranial hypertension had not abnormal imaging appearances.Conclusion Most lesions of the brain in AIDS patient may be detected by CT and MRI,but the definite diagnosis is still in need of combining with clinical appearances and other relative examination.

Objective To investigate the application value of the XT-4000i blood cell analyzer in body fluid cell count.Methods 113 cases of body fluid specimen were collected in the hospitalized patients from September 2013 to February 2014.Then RBC and WBC counts in the collected specimens were detected whitin 1 h by XT-4000i blood cell analyzer and the manual detection method, the RBC count values were divided into 3 levels:L1 100~1 000 ×106/L,L2 1 001 ×106 ~100 000 ×106/L and L3 > 100 000 × 106/L;WBC count values were divided into 2 levels:L1 1~50×106/L and L2 >50×106/L.The correlation between the two kinds of test methods was analyzed.Results The results of RBC and WBC counts detected by the XT-4000i blood cell analyzer and the manual method had a higher correlation.The correlation coefficients were 0.931,0.996,0.865,0.942 and 0.988.Conclusion The XT-4000i blood cell analyzer can be applied in clinical fluids cell count.