Objective To investigate the effect on incidence of ventilator associated pneumonia(VAP),the cost of hospitalization with closed endotracheal suctioning and vital sign as well in postoperative cardiac patients.Methods 304 postoperative cardiac patients supporting by ventilation were enrolled in this cohort study during January,2012-November,2013 in The Second affiliated Hospital& Yuying Children Hospital of Wenzhou Medical University.All the subjects were randomly divided into observational group and control group by coin side.Closed endotracheal suctioning system was applied in observation group and opened mode was applied in control group.Compare the vital sign(heart rate,blood pressure,saturation) at the moment of aspiration,suction time,incidence of VAP,duration of ventilation,mortality,the cost of suction,hospital stays and hospitalization expense.Results The baseline is no significant difference between two groups.The fluctuation of blood pressure and heart rate is lower in observational group at 30 second since completed the suction(P ＜0.05),but saturation is higher at 30 second and 60 second since completed the suction respectively(P ＜ 0.05).There is no significant difference of incidence of unexpected tube displacement and pneumothorax between two groups.Average time of each suction of experimental groups is shorter than Control groups[(156 ± 6) s vs (225 ± 8) s,t =-84.86,P ＜ 0.01].VAP incidence is lower in experimental group (12.0％ vs.18.6％,x2 =4.37,P ＜ 0.05).Duration of ventilation is lower in experimental group[(72 ± 33) h vs.(98 ± 38) h,t =-6.35,P ＜ 0.05].The cost of suction is higher in observational group [(346 ± 15) RMB vs.(178 ± 26) RMB,t =69.00,P ＜ 0.01],but the hospitalization expense is lower in experimental group [(32 011 ± 2 525) yuan vs.(35 264 ± 3 846)yuan,t =-8.72,P ＜ 0.05].There is no significant difference in mortality between two groups (x2 =0.08,P ＞ 0.05).Conclusion Application of closed endotracheal suction system can result in reduction vital sign fluctuation and incidence of cross infection and reducing the workload of nurses and decreasing the complication of suction,shorting the duration of ventilation and hospitalization and saving the expense of hospitalization in postoperative cardiac patients comparing with open mode.It is worthy to be populized in cardiac care unit.

Objective To study the expression of VEGF-C and its receptor in breast carcinoma tissue and in peritumoral tissue,as well as their clinic significance.Methods Immunohistochemistry SP method was used to examine the expression of VEGF-C and VEGFR3 in 70 cases of breast cancer and in its peritu- moral tissue.Results In all 70 cases of breast cancer,the positive expression rate of VEGF-C in breast car- cinoma tissue was 78.6 %,and its rate in peritumoral tissue was 54.3 %.There was a significant stastistic dif- ference between the two groups(P

Objective To investigate the efficacy of the bioactive artificial vertebrae of a nano- hydroapatite crystals and polyamide 66 composite(n-HA/PA66)to restore the height and architecture of thoracolumbar burst fracture.Methods From December 2003 to February 2006,38 patients(29 males and 9 females)with a mean age of 35.6 years(17-63 years)were treated surgically through anterior ap- proach for decompression and implanted with the bioactive artificial vertebrae of n-HA/PA66 composite to reconstruct the structure of the thoracolumbar burst fractured vertebra.Results All the patients were successfuly followed-up for an average of 8 months,ranging from 6 to 21 months.The bioaetive artificial vertebrac of n-HA/PA66 composite were fused with the receptor bone 3-4 months after operation.The neu- rological function of the patients was restored partially or completely.The thoracolumbar spine was stable during physical examination and the height of thoraeolumbar burst fractured vertebrae that had been restored did not changa during the follow-up.Conclusions Our results show the bioaetive artificial vertebrae of n-HA/PA66 can restore the height and structure of thoracolumbar burst fractured vertebrae and reconstruct the structure of the tboraeolumbar vertebrae effectively,indicating that the bioaetive artificial vertebrae of n- HA/PA66 can be used extensively in clinical spinal surgery.

OBJECTIVESalvia miltorrhiza Bunge (SMB) is a traditional Chinese herb, which is considered to promote blood flow and remove blood stasis. This study examined whether SMB can alleviate injury induced by hypoxia/reoxygenation (H/R) in human kidney proximal tubular cells-2 (HK-2 cells).

METHODSThere were 3 experimental groups: control, H/R injury and SMB-treated H/R injury. H/R injury of HK-2 cells was induced by first covering the cells with and then removing liquid paraffin wax. Different concentrations of compound SMB solution (0.05%, 0.10%, 0.15% or 0.20%) were administered to the SMB-treated H/R injury group before the hypoxic injury. After 4, 12 and 24 hrs of hypoxia and 4, 12, 24 and 48 hrs of reoxygenation, morphologic changes of HK-2 cells were observed under an inverted microscope. Cell viability was measured by the MTT method. Lactate dehydrogenase (LDH) activity in the culture supernatants was assayed using biochemical methods; TNF-alpha levels were determined by radioimmunoassay (RIA).

RESULTSThe number of HK-2 cells was significantly reduced in the H/R injury group after hypoxia, and reached a nadir 24 hrs after hypoxia treatment. Various concentrations of SMB-treated groups showed significantly greater number of HK-2 cells than the H/R injury group. SMB solution (0.10%) produced the best effect. The levels of LDH and TNF-alpha in the H/R injury group were significantly increased, and reached a peak between 24 hrs of hypoxia and 4 hrs of reoxygenation when compared to the control group. Pre-treating with 0.10% SMB resulted in significantly lower levels of LDH and TNF-alpha than in the untreated H/R injury group at various time points of H/R.

CONCLUSIONSSMB has protective effects against H/R injury of HK-2 cells, possibly through inhibition of inflammatory cytokines.

Calcium ; metabolism ; Cell Hypoxia ; Cells, Cultured ; Cytoprotection ; Drugs, Chinese Herbal ; pharmacology ; Humans ; Kidney Tubules, Proximal ; drug effects ; pathology ; L-Lactate Dehydrogenase ; metabolism ; Plant Extracts ; pharmacology ; Salvia miltiorrhiza ; Tumor Necrosis Factor-alpha ; analysis

OBJECTIVETo evaluate the potential repairing effects of low-intensity pulsed ultrasound (LIPUS) irradiation on acute horizontal alveolar bone defects at the mandibular pre-molar areas in Beagle dogs.

METHODSHorizontal alveolar bone defect models were established under enamelo-cemental junction 6 mm at the mandibular third and forth pre-molar buccal regions on both sides in 4 beagle dogs, and bilateral sides of each dog were randomly divided into two groups: Experimental groups with LIPUS irradiation (I(SATA) 30 mW X cm(-2), 20 min x d(-1)) and control groups without opening power source of LIPUS radiation. Dual energy X-ray bone densitometer was used to detect the bony density after an 8 weeks' irradiation. Meanwhile, decalcified bone tissue sections were used to assess the histological effects of new alveolar bone.

RESULTSThe results of new bony density detection in experimental group and control group were (0.6053 +/- 0.0566) g x cm(-2), (0.6047 +/- 0.0552) g x cm(-2), respectively, and there was no statistical significance between the differences of the two groups (P = 0.9839). Hematoxylin-eosin staining of decalcified bone tissue sections demonstrated that there were more osteoblasts lining at the edge of new alveolar bone in the experimental groups than that scattered in the control groups, and Masson staining revealed that collagens in new alveolar bone stained bright red indicating higher maturity in the experimental groups, while in the control groups mainly stained blue with some virescent areas indicating lower maturity.

CONCLUSIONLIPUS irradiation on acute horizontal alveolar bone defects has potential repairing effects.

Animals ; Bone and Bones ; Dogs ; Osteoblasts

OBJECTIVE: To investigate the method and clinical effect of the expandable intramedullary nails on fractures of extremities. METHODS: Nineteen cases of extremities long tubular bone fractures were treated with Fixion expandable intramedullary nails. RESULTS: Nineteen cases were followed up for 4-18 months,all cases healed without any complications. CONCLUSION The application of expandable intramedullary nails in the treatment of extremity fractures has the advantages of little trauma, simple operation, rigid fixation and high healing rate. It is a good treatment for fractures of extremities.
Adolescent ; Adult ; Bone Nails ; Extremities ; injuries ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Fractures, Bone ; surgery ; Humans ; Humeral Fractures ; surgery ; Male ; Middle Aged ; Tibial Fractures ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the association of ATP binding cassette transporter A1 (ABCA1) gene R219K polymorphisms with atrial fibrillation (AF) in Chinese population.

METHODSA total of 250 patients with AF and 250 control subjects were selected. Polymerase chain reaction-restricted fragments length polymorphism (PCR-RFLP) was used to determine the ABCA1 genotype, and the serum concentration of C-reactive protein (CRP) and high-density lipoprotein cholesterol (HDL-C) were measured in all the subjects.

RESULTSThe frequency of the RR , RK , KK , allele R , allele K genotype of ABCA1 in AF group and control group was 42.0%, 42.8%, 15.2%, 34.0%, 43.2% and 22.8%, 63.4%, 36.6%, 55.6%, 44.4%, respectively. The frequency of the KK genotype was significantly higher in the control group than in the case group (P=0.03), and the frequency of the allele K genotype was significantly different between the two groups (P=0.012). The serum CRP concentrations was significantly higher in AF group than in the control group (P=0.004), but serum HDL-C level showed no difference between the two groups. The serum CRP concentrations were significantly higher in patients with RR genotype than in those with KK genotype (P=0.013), and patients with RR genotype had significantly lower HDL-C level than those with RK and KK genotypes (P=0.009 and 0.027, respectively).

CONCLUSIONPatients with AF have elevated serum CRP level in comparison with healthy individuals, and the K allele of R219K polymorphism is an independent protective factor against AF.

ATP Binding Cassette Transporter 1 ; ATP-Binding Cassette Transporters ; genetics ; Aged ; Alleles ; Asian Continental Ancestry Group ; genetics ; Atrial Fibrillation ; blood ; genetics ; C-Reactive Protein ; metabolism ; Female ; Genetic Predisposition to Disease ; genetics ; Genotype ; Humans ; Male ; Middle Aged ; Polymerase Chain Reaction ; methods ; Polymorphism, Restriction Fragment Length

OBJECTIVETo investigate angiogenesis of collagen-chitosan porous scaffold, and to study survive of skin grafts on the scaffold after bilayer dermal equivalent (BDE) was transplanted on wounds with full thickness skin defects.

METHODSThe full thickness skin defects were made on 10 Bama miniature pigs and the BDE composed of collagen-chitosan porous scaffold and silicone membrane was transplanted on wound. Angiogenesis in dermal equivalent, wound healing, and healing and survive of skin grafts on dermal equivalent were observed in 1, 2, and 3 weeks after the BDE transplantation. At the same time, CD34 positive signals (neo-forming micro-vessels) were detected by immunohistochemical staining.

RESULTSInflammatory cells and fibroblasts infiltrated into dermal equivalent and a few new micro-vessels had been formed in 1 week after the BDE transplantation; neo-forming micro-vessels perpendicular to wound bed had increased significantly in 2 weeks after the BDE transplantation; neo-forming micro-vessels could be observed in almost all dermal equivalents in 3 weeks after the BDE transplantation. CD34 positive signals (neo-forming micro-vessels) in 3 weeks after the BDE transplantation was much more than those in 2 weeks after the BDE transplantation, and CD34 positive signals in 2 weeks after the BDE transplantation was much more than those in 1 week after the BDE transplantation. Survival rate of intermediate split thickness skin graft were 10%, 70% and 100% respectively after the skin grafts had been grafted for 2 weeks on surface of the scaffold which had been transplanted for 1, 2 and 3 weeks. Epidermis which had been grafted on surface of the scaffold for 1 or 2 weeks could perfectly survive after BDE had been transplanted for 1 or 2 weeks.

CONCLUSIONSCollagen-chitosan porous scaffold plays a very important role in wound healing of full thickness skin defect and can induce fibroblast infiltration and new micro-vessel formation. Epidermis grafted on surface of collagen-chitosan porous scaffold can perfectly repair wounds, and it has brilliant applied prospects in repairing skin defect.

Animals ; Chitosan ; Collagen ; Disease Models, Animal ; Female ; Graft Survival ; Neovascularization, Physiologic ; Silicones ; Skin ; injuries ; Skin Transplantation ; Swine ; Swine, Miniature ; Tissue Scaffolds ; Wound Healing

BACKGROUNDAlthough heart transplantation has become a standard therapy for end-stage heart disease, there are few published studies regarding the use of transplant organs from marginal donors. Here we describe the clinical outcome we have obtained using marginal donor hearts.

METHODSWe analyzed 21 cases of orthotopic heart transplantation for end-stage heart disease performed in our department between September 2008 and July 2010. Of these patients, six received hearts from marginal donors and the remainder received standard-donor hearts. The two groups were compared in terms of both mortality and the incidence of perioperative complications such as infection, acute rejection, and right heart insufficiency.

RESULTSThe 1-year survival rate of both groups was 100%. Only one death was recorded in standard-donor group during follow-up. Patients who received marginal donor hearts (83%) experienced more early complications than did the standard-donor-heart group (13%), but the mortality of the two groups was the same. The duration of post-ICU stay was greater in the marginal donor group than in the standard-donor group, (35.5 ± 17.4) days and (21.7 ± 2.6) days, respectively (P < 0.05).

CONCLUSIONSThe use of marginal donor hearts increases the number of patients who can receive and benefit from transplants. However, it may introduce an increased risk of early complications, thus care should be taken both in the choice of patients who will receive marginal donor hearts and in the perioperative treatment of those for whom the procedure is performed.

Adult ; Antibodies, Monoclonal ; therapeutic use ; Female ; Heart Transplantation ; methods ; Humans ; Immunosuppressive Agents ; therapeutic use ; Male ; Methylprednisolone ; therapeutic use ; Middle Aged ; Recombinant Fusion Proteins ; therapeutic use ; Tissue Donors

OBJECTIVETo investigate the clinicopathologic features of lymphoplasmacytic lymphoma (LPL) with Waldenström's macroglobulinemia (WM) and to evaluate the usefulness of immunophenotype analysis in diagnosis and differential diagnosis of the tumor.

METHODSA total of 40 cases of LPL with WM diagnosed according to the 2008 World Health Organization classification of tumors of hematopoietic and lymphoid tissues were analyzed using immunophenotype and follow-up information.

RESULTSThe mostly common initial clinical presentations were non-specific symptoms, such as fatigue, anemia and hemorrhage. Lymphadenopathy, splenomegaly and hepatomegaly were found in 42.5%, 20.0% and 12.5% of the patients respectively. The pattern of bone marrow involvement included mixed type (47.2%), diffuse type (41.7%) and interstitial type (11.1%). The nodal architecture was completely destroyed in one case and partially effaced with residual germinal centers and dilated sinuses in 8 cases. All of the neoplastic cells expressed CD20 and CD79a. Neoplastic plasma cells were positive for CD138 and CD79a. No cases expressed CD5. Four cases weakly expressed CD23. No significant prognosis related factors were identified in the survival analysis.

CONCLUSIONSLPL with WM is a rare indolent small B-cell lymphoma, which is commonly seen, in older male patients. The tumor frequently involves bone marrow and shows various clinical manifestations. Combination analyses of the bone marrow biopsy histology, immunophenotypic study and clinical data, especially the serum examination are important for the diagnosis of LPL with WM.

Adult ; Aged ; Aged, 80 and over ; Antigens, CD20 ; metabolism ; Bone Marrow ; metabolism ; pathology ; CD79 Antigens ; metabolism ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Immunoglobulin M ; blood ; Immunophenotyping ; Leukemia, Lymphocytic, Chronic, B-Cell ; metabolism ; pathology ; Lymphatic Metastasis ; Lymphoma, B-Cell, Marginal Zone ; metabolism ; pathology ; Lymphoma, Follicular ; metabolism ; pathology ; Lymphoma, Mantle-Cell ; metabolism ; pathology ; Male ; Middle Aged ; Multiple Myeloma ; metabolism ; pathology ; Neoplasm Invasiveness ; Survival Rate ; Syndecan-1 ; metabolism ; Waldenstrom Macroglobulinemia ; immunology ; metabolism ; pathology