Objective To explore the mechanism of macro-reentry atrial tachycardia and to guide catheter ablation using electroanatomic mapping system in 3 patients.Methods Three patients(two females),aged 51?12 years,with atrial tachycardia were included.The mean history of symptom was 19?11 years.Conventional electrophysiological study was performed to determine the location of atrial tachycardia before the three dimensional geometry reconstruction.After voltage and activation maps were constructed,the mechanism of tachycardia was analyzed and the slow conduction areas(critical isthmus) were verified.Radiofrequency energy was delivered using irrigated-tip catheter.Results Though there was no evidence to suggest structural heart diseases,scar areas were found in the mapped atria in all the three cases.The mechanism of atrial tachycardia was found to be counter-clockwise macro-reentry around tricuspid valve,counter-clockwise macro-reentry around superior vena cava,and figure "8" reentry in left atria in the 3 patients respectively.The respective critical isthmus was found to be between the lateral scar and tricuspid valve,the lateral scar and superior vena cava,and two scars on the left atria roof.Ablation in the critical isthmus terminated all tachycardia.There were no atrial tachycardia recurrence during a follow-up of 9-10 months.Conclusion The substrate and electrophysiological mechanism of macro-reentry atrial tachycardia could be identified clearly,and navigation ablation could be performed effectively under the guidence of electroanatomic mapping.

Objective To explore the expression of glutathione-S-transferase-π(GST-π),P-glycoprotein (P-gp),topoisomerase Ⅱ (Topo Ⅱ) and thymidylate synthase (TS) in gastric adenocarcinoma tissues and the clinical significance.Methods Envision method of immunohistochemistry was used to detect the expression of GST-π,P-gp,Topo Ⅱ and TS in sample of 64 gastric adenocarcinoma tissues and 12 normal gastric mucosas,and their corresponding clinical data were comprehensive analyzed.Results The expression positive rates of GST-π,P-gp,Topo Ⅱand TS were respectively 76.6 ％(49/64),64.1％ (41/64),84.4 ％ (50/64) and 53.1％ (34/64),that were all higher than in gastric mucosa [8.3 ％ (1/12),8.3 ％(1/12),16.7 ％ (2/12),0],the differences were statistically significant respectively (P ＜ 0.01).Their positive expression rates were closely relevant to the degree of differentiation (P ＜ 0.05),but not to the patients' gender,age,tumour size,clinical staging,invasive depth and lymph node metastasis (P ＞ 0.05).The expressions of GST-π,P-gp and TS in high and middle differentiation adenocarcinoma were high.er than in low differentiation,but the expression of Topo Ⅱ in high and middle differentiation adenocarcinoma was lower than in low differentiation (P ＜ 0.05).Conclusion GST-π,P-gp,Topo Ⅱ and TS are over-expressed in gastric adenocarcinoma,which is related to the multidrug resistance of gastric adenocarcinoma.The joint detection of the expression of GST-π,P-gp,Topo Ⅱ and TS in gastric adenocarcinoma can be looked as an important symbol for guiding its chemotherapy drug and prognosis.

Objective To discuss the nursing management method in the cardiovascular intensive care unit. Methods The management evaluation standard was set up and the comprehensive evaluation of quality (CEQ) was introduced according to factors influencing nursing quality. Results The nursing quality control data and complications after operation before and after the application of CEQ were statistically different. Conclusions Nursing management should innovate unceasingly and comprehensive quality evaluation is one of the effective nursing management method.

This article showed the work pattern of rehabilitation assessment, and made assessment of a patient who suffered from bilat-eral hemiplegia and pseudobulbar paralysis caused by multiple cerebral apoplexy. Finally, the special characteristics of rehabilitation treat-ment for a patient with bilateral paralysis were summarized.

BACKGROUND:Many studies have showed that neural stem cells therapy is a new strategy for hypoxic-ischemic encephalopathy.
OBJECTIVE:To review and analyze the status of research, transplantation strategies and mechanism of neural stem cells therapy for treatment of hypoxic-ischemic encephalopathy.
METHODS:A computer-based retrieval was performed in PubMed and CNKI database to search papers published from August 2000 to August 2013 using the key words of“hypoxic-ischemic encephalopathy, neural stem cells”in English and Chinese. The papers with objective-independent and repetitive contents were excluded, and final y 39 papers were included for final analysis.
RESULTS AND CONCLUSION:Neural stem celltransplantation can promote recovery of neurological function, which brings new hope to hypoxic-ischemic encephalopathy patients. But the study is at a primary stage and limited in laboratory. There are many critical factors that hinder the clinical transplantation, such as delivery path, transplantation time, single or combined transplantation, mechanisms of action. Application of neural stem cells requires further investigation.

Objective To investigate the clinical application of fast track surgery in patients undergoing elective colorectal carcinoma surgery. Methods Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: fast-track group (35 cases) and conventional care group (35 cases). Results Sixty-two patients finished the study, 32 cases in fast-track group and 30 cases in conventional care group. The median and average time to the first passage of flatus (2±1 vs. 4±2, P<0.01), the first passage of stool (3.8±1.6 vs. 6.4±2.5, P=0.0007), resumption of normal diet [(4±2) vs. (8.2±2.2), P<0.01] and the length of postoperative stay (6±1 days vs. 11.7±3.8 days, P<0.01) were much shorter in the fast-track group than in the conventional care group. The preoperative incidence of thirst (2/32 vs. 23/30, P<0.01), hunger (5/32 vs. 20/30, P<0.01) and postoperative infectious complications (2/32 vs. 8/30, P=0.04) were much lower in the fast-track group than in the conventional care group. Conclusion Fast track surgery in patients undergoing elective colorectal resection was safe and effective.

Thymus is an important immune organ in mammals.FoxN1 plays an important role in regulating the development of thymic epithelial cells.Pig is a domestic animal of meat type,and is also a new kind of experimental animal model.In order to better understand the development characteristics of pig own immunity,the expression pattern of Minzhu FoxN1 in 2 month,4 month,6 month and 8 month thymus were detected by real-time PCR and Western-blot.At the same time,the changes of FoxN1 expression in Minzhu and Large white pig after cold stress were also detected.The results showed that FoxN1 expression level reached the highest level in 4 month,and declined in 6 month.This expression pattern is consistent with human and mouse.Cold stress could rise the expression level of Minzhu FoxN1,while have no effect on the Large white pig.

Objective Chronic atrial fibrillation (AF) results in dedifferentiation of atrial cardiomyocytes that plays an important role in the perpetuation of AF.In this study,we aimed to investigate the changes of titin and α-smooth muscle actin (α-SMA) after long time of AF reversal.Methods Twenty-four goats were randomized into four groups:(1) sinus rhythm (SR),(2) 3 months AF (3-mo AF),(3) 3 months SR after 3 months AF (3-mo post AF),(4) 6 months SR after 3-mo AF (6-mo post AF),with 6 in each group.By pacing on the anterior bottom of left atria appendage (LAA),we established a goat model of chronic AF.Atria effective refractory period (AERP) was measured with electrophysiological methods.Ultra-structure was studied with echocardiography,light and electron microscopy.Titin and α-SMA protein expressions were determined by Western blot.Results The animals underwent high rate pacing on LAA for a mean of 42.23±21.70 days before presenting AF.Electrophysiological analysis revealed that AERP completely resumed in 3-mo post AF goats.Echocardiography displayed that the size of left atrium resumed almost in 6-mo post AF goats (P＜ 0.01).Pathological and electron microscopic examination revealed the disorder of myofibrils,augmentation of intercellular space,myolysis,accumulation of glycogen,and numerous bigger mitochondria among atrial cardiomyocytes in 3-mo AF goats.They recovered mostly in 6-mo post AF goats.Western blot showed that the band density of titin significantly reduced in 3-mo AF goats compared to SR ones [1826±319 vs 5012±854,P＜0.01].In 3-and 6-mo post AF goats,titin increased gradually and it reversed completely in 6-mo post AF goats (3841±601 and 4523±833 respectively,P ＜ 0.01).Conversely,the band density of α-SMA was significantly higher in 3-mo AF goats (5324±948) than in SR ones (1619± 271,P＜0.01).In 3-and 6-mo post-AF goats,α-SMA decreased gradually,and it recovered mostly in 6mo post AF goats (4437± 792 and 2205±540 respectively,P＜0.01,).Conclusions These data indicate that the reversal of dedifferentiation of atrial cardiomyocyts is a very slow process,and it is definitely essential for normal cardiac function.

Objective The aim of this study was to determine the effect of a new method of cardiac assistant therapy with an extra-aortic balloon pump on the experimental dogs in which myocardial ischemia or infarction were induced, and to ob serve its effectiveness and feasibility. Methods Twelve animal models of myocardia 1 infarction were established with the method of left anterior descending coronary artery ligation. They were divided randomly into two groups, six in the experimental group and six in the untreated group. The end points observed were the differences between the two groups in the blood pressure, cardiac function, myocardial enzymes, infarction size and routine blood variables before procedure, 1,2, 3, 4, 5 and 6 hours after myocardial infarction. Results All six dogs in the experimental group were survived, with a mortality rate of 0.The number of death in the control group was three, with a mortality rate of 50%. Measurements such as mean blood pressure,cardiac output, cardiac index in the experimental group were better than those in the control group ( P ＜ 0.05 ). Mean heart rate before myocardial infarction in the experimental group was 156 beats per minute, as compared with 148 beats per minute in the control group, and was 128 vs. 67 beats per minute respectively six hours after myocardial infarction. The cardiac output was 3.48 vs. 4.98 liters per minute before myocardial infarction and was 6.10 vs. 0.85 liters per minute six hours after myocardial infarction. The average pressure was 94 mm Hg vs. 99 mm Hg before myocardial infarction and was 70 mm Hg vs. 33 mm Hg six hours after myocardial infarction. Conclusion The extra-aortic balloon pump significantly improved the hemodynamic variables of the experimental animals after myocardial infarction and reduced mortality. Injury to the blood cells may be the potential disadvantage.

Objective To investigate the expression and significance of detecting carbonic anhydrase Ⅸ(CAⅨ), pax-illin (paxillin) and somatostatin receptors (SSTR) in patients with duodenal carcinoma. Methods The immunohisto-chemistry was used to detect 87 cases of duodenal carcinoma carbonic anhydrase Ⅸ (CA Ⅸ), paxillin (paxillin) and somatostatin receptors (SSTR) expression. Results Among 87 cases of duodenal cancer, CA Ⅸ positive rate of 71.3%(62/87), paxillin positive rate of 74.7% (65/87), was significantly higher than other groups (P<0.05). The rate of so-matostatin receptor-positive rate of 48.2%(42/87),was significantly lower than than other groups (P<0.05). And the positive rate of duodenal CA Ⅸ poorly differentiated cancer group, the positive rate of protein pile, SSTR-positive rate compared with the well-differentiated group (P<0.05). The positive rate of M1 CA Ⅸ of duodenal papilla cancer, the positive rate of paxillin, SSTR-positive rate compared with M0 stage(P<0.05). Conclusion Carbonic anhydrase Ⅸ(CAⅨ), occurrence, development and metastasis of somatostatin receptor (SSTR) and paxillin and three closely related duodenal cancer, can serve as an important indicator of early diagnosis of cancer, can also be used to assess tumor development and prognosis.