Clinical data of 151 patients with acute occlusion of right coronary artery were retrospectively analyzed.Coronary angiography and electrocardiography (EEG) were performed in all 151 patients,angiography showed proximal-middle segment occlusion in 114 cases and distant segment occlusion in 37 cases.The correlation of ECG findings with coronary artery occlusion sites was analyzed.Results showed that EEG findings related to proximal-middle segment occlusion were:ST segment elevation in lead V4R ≥0.05 mV,Ⅲ degree atrioventricular block,ST segment depression in lead Ⅰ ＞0.1 mV,ST segment depression in lead AVL≥0.2 mV,ST segment elevation in lead l ≥0.25 mV,the total ST depression in lead V2,V3 and V4 ≥0.4 mV,the total ST depression in lead Ⅰ and aVL ≥0.25 mV;among which ST depression of Lead Ⅰ ＞0.1 mV,ST elevation of Lead V4R ≥0.05 mV and Ⅲ degree atrioventricular block were used to predict occlusion of proximal-middle segment of right coronary artery with 100％ specificity.ECG findings related to distal segment occlusion were:ST depression in lead Ⅰ ≤ 0.1 mV,ST segment depression in lead AVL ＜0.2 mV,ST elevation in lead Ⅲ ≤0.25 mV,the total ST depression in lead V2,V3 and V4 ＜ 0.4 mV,ST segment were not depression in lead V1-V5,the total ST depression in lead Ⅰ and aVL ＜ 0.25 mV.Based on a 4-step flow method,ECG might be adopted to identify the acute occlusion sites in proximal-middle segment and distal segment of right coronary.

Objective To investigate the effect of butylphthalide and sodium chloride injection postconditioning on focal cerebral ischemia-reperfusion (I/R) injury and endoplasmic reticulum stress in rats.Methods Thirty-six male SPF Sprague-Dawley rats,aged 2-3 months,weighing 260-280 g,were randomly divided into 3 groups (n =12 each):sham operation group (group S),focal cerebral I/R group (group I/R) and butylphthalide and sodium chloride injection postconditioning group (group Buty).The animals were anesthetized with intraperitoneal 10 ％ chloral hydrate 300 mg/kg.Focal cerebral I/R was induced by occluding right middle cerebral artery for 2 h followed by 24 h reperfusion in I/R and Buty groups.Butylphthalide and sodium chloride injection 2.5 mg/kg was injected via the tail vein immediately after onset of reperfusion in Buty group,while the equal volume of normal saline was injected in I/R group.Neurological deficits were assessed and scored at 24 h of reperfusion,and then the brain was isolated for detection of neuronal apoptosis (by TUNEL) and the expression of glucose-regulated protein 78 (GRP78) and caspase-12 in ischemic cerebral cortex (by immunohistochemistry) in brain tissues.Apoptosis index was calculated.Results Compared with group S,the neurological deficit scores and apoptosis index were significantly increased,and the expression of GRP78 and caspase-12 was up-regulated in I/R and Buty groups (P ＜ 0.05 or 0.01).Compared with group I/R,the neurological deficit scores and apoptosis index were significantly decreased,the expression of GRP78 was up-regulated,and the expression of caspase-12 was down-regulated in group Buty (P ＜ 0.05).Conclusion Butylphthalide and sodium chloride injection postconditioning can reduce focal cerebral I/R injury in rats,and inhibition of endoplasmic reticulum stressmediated cell apoptosis is involved in the mechanism.

Objective:To explore effect of serum leptin level on nutriture in the patient of chronic renal failure(CRF)and the relation with TCM syndrome types of CRF.Methods:110 cases in CRF group were divided into 5 subtypes and 30 normal persons were used as control group.Serum leptin level,body height,body weight,and body mass index(BMI)were determined in both groups;and serum albumin,serum pre-albumin,transferin,serum creatinine,urea nitrogen,C-reaction protein,blood insulin,and nutrition risk index(NRI)were detected in CRF group.Results:Serum leptin level in CRF group was higher than that in the control group,and leptin level and nutritional index level in both the subtype groups of Qi-and Yang-deficiency of spleen and kidney were significantly different with those in other 3 subtype groups.Conclusion:High blood leptin is possibly one of the reasons inducing malnutriture of CRF patient,and serum leptin is possibly a partial basis of substances of Qi-and Yang-deficiency syndrome of CRF.

Objective To obtain more detailed microsurgical anatomical data and multi-slice helical CT scanning of cochlear aqueduct for the translabyrithine approach. Methods Twenty cadaver heads(40 sides)fixed with formalin were dissected under a microscope ,and cochlear aqueducts were found and measured. Five cadaver heads(10 sides) were scanned by multi-slice helical CT. Results The width of external aperture of cochlear aqueduct was (2.64?0.82)mm. The length of cochlear aqueduct was (8.40?1.35)mm. The distance between cochlear aqueduct and cranial nerves Ⅸ, Ⅹ, Ⅺ, and that between the inferior petrosal sinus was(1.08?0.36 )mm,(2.71?0.63)mm,(4.52?1.25)mm, (1.14?0.46)mm, respectively. The distance between external aperture of cochlear aqueduct and the inferior margin of internal acoustic meatus aperture was (5.53?0.93)mm. The otic capsule segment of cochlear aqueduct could not be demonstrated on the coronal section. The petrosal portion could be demonstrated by both coronal and axial scannings. Conclusion The axial scanning was useful for detecting cochlear aqueduct. Cochlear aqueduct could be regarded as one of the landmarks in translabyrithine approach for cerebellopontile angle operation.

10.3969/j.issn.2095-4344.2013.26.011

Objectives: To evaluate the efficacy of phacoemulsification and foldable IOL implantation with limbal tunnel incision.　Methods: A 3.2mm limbal tunnel incision was made on 72 eyes of 66 patients with senile, complicated and traumatic cataract. Phacoemulsification and foldable IOL implantation was performed. Visual acuity, corneal curvature and corneal topography were measured after the surgery.　 Results: One day, one week and one month after the surgery, visual acuity exceeded 0.5 in 69.4%, 80.6%,86.1% of the patients respectively. One week after the surgery, the mean astigmatism was (1.85±0.89)D(P<0.01), 0.30 D more than that before the surgery. Corneal topography showed that the incision was steep or flat. One month after the surgery, the mean astigmatism was (1.48±1.02)D，P>0.05,corneal topography had recovered.　 Conclusions: Phacoemulsification and foldable IOL implantation with limbal tunnel incision have comparatively simple, with less postoperative inflammation and faster recovery of visual acuity.

Objective To understand the nosocomial infection distribution,drug resistance characteristics and carbapenemases-producing phenotype of Pseudomonas aeruginosa (PAE)and Acinetobacter baumannii (ABA).Methods The nosocomial infection strains of non-repeated PAE and ABA isolated in this hospital and the infected cases from July 2012 to July 2013 were retrospec-tively collected.The antimicrobial susceptibility test was conducted by the disk diffusion method(K-B method).The modified Hodge test was adopted to preliminarily screen carbapenemase and the positive strains of preliminary screening were further detected met-allo-beta-lactamase(MBL)by 2-mercaptopropionic acid synergy test.Results During the study period,250 strains of non-repeated PAE and 132 strains of ABA were included.All of them were primarily isolated from sputum specimens,accounting for 55.5%.The department distribution was dominated by the intensive care units(ICU),accounting for 20.9%.The antimicrobial susceptibility test showed that the sensitivity of PAE to the testing anti-microbial drugs was more than 70%,its resistance rates to IPM and MEM were 8.5% and 9.5% respectively.However,the resistance rates of ABA to the testing anti-microbial drugs were up to 35.2%-77.4%,its resistance rates to IPM and MEM were 35.2%,39.1% respectively.The occurrence rates of multidrug-resist-ant and pandrug-resistant ABA nosocomial infection was higher than that of PAE,which were 44.7% and 24.0% and 9.1% and 2.8%,respectively.Among 40 strains of carbapenem-resistant PAE,11 strains(27.5%)were positive in the preliminary screening and 2 strains(18.2%)were positive of MBL phenotype.Among 49 strains of carbapeneme-resistant ABA,37 strains(75.5%)were positive in the preliminary screening and only 1 strain(2.7%)was positive of MBL phenotype.Conclusion PAE and ABA in our hospital exhibit different resistance to common antibacterial drugs.The monitoring should be strengthened.The production of car-bapenemsa is one the main mechanisms for PAE resistance to carbapenems.The detection rate of MBL-producing PAE and ABA is lower in our hospital.

Objective To analysis the effect of stem cell transplantation on serum homocysteine ( Hcy ) , C reactive protein ( CRP ) and brain derived neurotrophic factor( BDNF) in patients with ischemic stroke.Methods 42 patients who were diagnosed with ischemic stroke in Yichang First People's Hospital were collected.All patients were randomly divided into experimental group and control group, 21 cases in each group.The control group was treated with conventional therapy, and the experimental group was treated with autologous bone marrow mesenchymal stem cell transplantation for treatment on the basis of conventional therapy, after treatment, the serum levels of serum homocysteine, CRP, BDNF and clinical curative effect were detected in all patients.Results After treatment, compared with control group, the serum Hcy level was lower in the experimental group(P<0.05);the serum CRP level was lower in the experimental group (P<0.05); the serum BDNF level was higher in the experimental group (P<0.05); the FIM, ADL and Fugl-Meyer score were higher in the experimental group(P <0.05).Conclusions The stem cell transplantation can significantly reduce the serum Hcy and CRP levels in patients with ischemic stroke, increase the content of BDNF in serum, improve the therapeutic effect, and have a guiding significance for clinical.

Objective To analyze the curative effect of super-early keyhole surgery in treatment of hypertensive cerebral hemorrhage. Methods Clinical data of patients with hypertensive cerebral hemorrhage who received treatment in our hospital from April 2010 to October 2012 were retrospectively analyzed. Patients were divided into the observation group ( keyhole surgery group) and the control group ( routine group) by different therapeutic methods. The operation time, rate of hematoma clearance, postoperative complications, and recovery of neu-ral function of the two groups were compared. Results The observation group had a shorter operation time than the control group, and the difference was statistically significant(P<0. 001). There was no singnificant difference between the two groups in rate of hematoma clear-ance at the time of tube drawing(P>0. 05). The observation group had less postoperative complications than the control group, and the difference was statistically significant(P<0. 05). The observation group had a lower rate of metabolic disorders than the control group with a statistically significant difference(P<0. 05). Patients of the observation group had a higher scores of SSS than patients of the control group 28 days after operation, and the difference was statistically significant(P<0. 05). 6 months after operation, the observation group had a bet-ter ADL than the control group, and the difference was statistically significant(P<0. 05). Conclusion Super-early keyhole surgery which has less intraoperative injury, postoperative complication, and metabolic disorders, can achieve a better effect than routine operation. And it is of better neural functional recovery.

Object To study the origin, morphology and histology of Galla Cinnamomi Camphorae(GCC). Methods By the literature investigation and the survey in the production area, GCC was identified by microscopic technique. Results The origin and the medicinal part of GCC were defined. Conclusion GCC is the abnormal fruit of Cinnamomum camphora (L.) Presl which has been infected by Exobasidium sawadae Yamada and formed with hymenium and fruit. The characters in morphology and histology of GCC provide the scientific reference of identification of the crude drug.