Objective To summarize the clinical treatment experience of blood culture-negative infective endocarditis,and to explore the surgery chance and therapeutic strategy of blood culture-negative endocarditis. Methods One hundred and sixty-six patients who were diagnosed blood culture-negative endocarditis in the Aisa Heart Hospital of Wuhan from Jul. 2008 to Dec. 2012 were recruited in the study. Broad-spectrum antibiotics including cefuroxime axetil and levofloxacin were used before the result of blood culture,and sensitive antibiotics were selected to control patient's condition when getting the result of blood culture. But broad-spectrum antibiotics were continuously used to the blood culture-negative endocarditis until stable condition. When the conditions were stable,active preparation before surgery should be carried out. Thoroughly clear the vegetation and protect the cardiorespiratory function during operating. Kata-step antibiotics were used to control patient's condition until normal temperature,as well as the number of leukocytes decreased,blood sedimentation normalized and C-reaction protein decreased. Then,the narrow-spectrum antibiotics were selected including cephalosporin until discharged from hospital,and continued treatment of antibiotics for 4 - 6 weeks. Results Five patients died after the operation,including 1 case died of low cardiac output syndrome,2 cases died of multiple organ failure,1 case died of septicemia and the 1 case died of cerebral embolism. All the other patients discharged from hospital successfully. Conclusion The patients with blood culture-negative IE should be controlled rapidly. The duration and dose of antibiotics should be enough. Active operative preparation should be taken and then surgery timely. Thus,the hospital mortality could decrease and prompt the long-term outcome.

OBJECTIVETo observe preliminary efficacy of decompressive unilateral improved transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degenerative diseases.

METHODSFrom August 2009 to December 2011, 28 patients with lumbar degenerative diseases were treated by decompressive unilateral improved TLIF,including 16 males and 12 females with an average of 61 (aged 46 to 71) years old,the courses of disease ranged from 6 months to 6 years. Among them, 20 cases suffered from lumbar spinal stenosis, 8 cases were lumbar disc herniation. Decompressive range included single segment in 24 cases,and double segments in 4 cases; 15 cases were performed operation on the left side, 13 cases on the right side. JOA lower back pain scoring system (29 points) were applied for evaluate preoperative and postoperative symptoms, physical signs and sphincteral functions;Visual analogue scale (VAS) were used to evaluate preoperative and postoperative low back pain.

RESULTSAll patients were followed up 6 to 28 (mean 14) months. Postoperative JOA score and VAS score were 17.9 +/- 2.2, 2.8 +/- 0.7 respectively,and preoperative JOA score and VAS score were 8.5 +/- 1.7, 8.6 +/- 1.2, respectively. There were significant meaning in JOA and VAS scores before and after operation (P < 0.05). Twenty-eight patients were all obtained intervertebral synostosis.

CONCLUSIONDecompressive unilateral improved TLIF for treatment of unilateral radicular lumbar spinal stenosis and lumbar disc herniation,which has advantages of minimally invasive,curative effects,decrease medical costs,is worthy spreading in clinical.

Adult ; Aged ; Decompression, Surgical ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Spinal Diseases ; surgery ; Spinal Fusion ; Treatment Outcome

AIM: To determine the contents of tetrandrine and fangchinoline in Qingshenjianfei Tablets by RP-HPLC. METHODS:In this method Zorbax C 18 column was used, and methanol—0.3%diethylamine (75∶25) as a mobile phase , the detection wavelength was at 242 nm. RESULTS:The recovery of tetrandrine was 103.65% and RSD was 1.59% .The recovery of fangchinoline was 97.11% and RSD was 1.91% (n=6). CONCLUSION: This method is simple,quick,reproducible and can be used for the quantitative analysis。

Objective To explore the cause of acute myocardial ischemia early after coronary artery bapass graft (CABG) and surgical management on it. Methods From 2001 to 2009, 28 patients underwent urgent reoperation early after CABG due to acute myocardial ischemia. The incidence of reoperation is about 0.02%. The cause of reoperation inclouded early graft occlusion (10 cases) ,IMA damage or injury during harvesting(9 cases), inexactitude distal anastomosis(2 cases)and radial artery spasm(4 cases). The mean interval time between two operations was 8 hours. Reoperation was done under offpump bypass in 2 patients and on-bypass used in other patients. Unsatisfactoey graft were substituted with new graft material and thrombotic was removed. If LIMA was the reson for myocardial ischemia, an additional vein graft was inserted. The spasm radial artery were substituted with new vein graft. Completely revascularization was used in re-do CABG. Results Two patients died during reoperation. 8 patients was died between 1 day and 14 days after reoperation. IABP was used in 16 patients,which 2 patients received ECMO suppord and 2 patient received LVAD suppord at mean time. Conclusion There have very high mortality in acute myocardial ischemia early after CABG. The early diagnosis and correct surgical management can improve the rates of survival. The active prevent should be emphasized during the first CABG.

Objective To investigate the predictive value of 4 183 Da peptide of dermcidin protein in the early diagnosis and differential diagnosis of ischemic heart disease.Methods A prospective controlled study was conducted.Serum samples were drawn from 161 patients with acute coronary syndrome [ACS,including 46 patients with unstable angina (UA),23 with acute non-ST elevation myocardial infarction,and 92 with acute ST segment elevation myocardial infarction],111 subjects for routine physical examination,including 45 patients with hypertension history,42 with coronary heart disease,22 with diabetes,and 54 patients with non-ACS (including pulmonary embolism,aortic dissection aneurysm,arrhythmia,myocarditis,coronary myocardial bridge,pleurisy,pneumothorax,pneumomediastinum,rib fracture,reflux esophagitis,peptic ulcer,and pancreatitis) to serve as controls.4 183 Da peptide of dermcidin protein was assessed with matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) technology,and myeloperoxidase [MPO,determined by point-of-care testing (POCT) and enzyme linked i mmunosorbent assay (ELISA),respectively],high sensitive C-reactive protein (hs-CRP),heart type fatty acid binding protein (H-FABP),myoglobin (MYO),cardiac troponin Ⅰ (cTnⅠ),and MB isoenzyme of creatine kinase (CK-MB) were quantitated with biochemical analysis.The power of the biomarkers above for early diagnosis and differential diagnosis for ischemic heart disease were judged by comparison of their sensitivity and specificity.Results ① It was showed by one-way ANOVA that 4 183 Da peptide was higher in ACS group than that in control group (relative abundance:22.05 ± 16.97 vs.15.52 ± 14.09,P =0.001),but no difference was found between ACS group and non-ACS group (relative abundance:22.05 ± 16.97 vs.19.99 ± 17.63,P =0.416).② The specificity and sensitivity of the 4 183 Da polypeptide and MPO for predicting ACS and UA were compared with the receiver operating characteristic curve (ROC).It was showed that the 4 183 Da polypeptide had predictive values for ACS and UA,and the areas under the ROC curve (AUC) was 0.625 and 0.651 (both P ＜ 0.01),but MPO was not found to have predictive value (AUC was 0.440 and 0.336,respectively,both P ＞ 0.05).③ It was showed by the values of multi-markers in differential diagnosis of ACS and non-ACS disease that the specificity and sensitivity of 4 183 Da peptide in the differential diagnosis of acute myocardial infarction (AMI) and non-ACS disease were less than those of MYO,cTnⅠ,H-FABP,markers of myocardial damage,which AUCs were 0.569 vs.0.796,0.833,0.838,and equal to MPO (POCT/ELISA) and hs-CRP,AUC of which was 0.569 vs.0.505 (POCT)/0.477 (ELISA) and 0.545.But both the value of 4 183 Da peptide and MYO,cTnⅠ,H-FABP in the differential diagnosis of UA and non-ACS disease was not found,where AUC was 0.456,0.525,0.658,0.568.Conclusion 4 183 Da polypeptide,a fragment of dermcidin protein,may have association with the onset of ischemic heart disease,and may be helpful in the early diagnosis of ACS.

High-speed counter-current chromatography (HSCCC) was used to high performance separate and prepare lignans from Schisandrae chinensis fructus. The solvent system is composed of n-hexane-ethyl acetate-methanol-water (9 : 1 : 5 : 5) and n-hexane-ethyl acetate-methanol-water (9 : 1 : 9 : 5), speed is at 900 r.min-1, and flow rate is at 2.0 mL.min-1. Five fractions from Schisandrae chinensis fructus extract were separated and prepared with one HSCCC process. They were identified as schisandrin, gomisin J, schisandrol B, schisantherin A and deoxyschizandrin by electrospray ionization-multiple tandem mass spectrometry (ESI-MSn), respectively. Their contents were obtained in 98.74%, 94.32%, 99.53%, 94.23% and 98.68% by ultra high performance liquid chromatography (UPLC), separately. The rapid and simple method can be applied for the preparation of lignans from Schisandrae chinensis fructus.
Countercurrent Distribution ; Cyclooctanes ; chemistry ; isolation & purification ; Dioxoles ; chemistry ; isolation & purification ; Drugs, Chinese Herbal ; chemistry ; isolation & purification ; Fruit ; chemistry ; Lignans ; chemistry ; isolation & purification ; Molecular Structure ; Plants, Medicinal ; chemistry ; Polycyclic Compounds ; chemistry ; isolation & purification ; Schisandra ; chemistry ; Spectrometry, Mass, Electrospray Ionization ; Tandem Mass Spectrometry

Objective To analyze the profile of dermcidin (DCD) changes in different stages of acute coronary syndrome (ACS) by quantifying the serum 4 183Da DCD peptide fragment deriving from different ACS patients treated with early antithrombotic therapy.Methods A total of 118 patients with confirmed diagnosis of ACS were enrolled. Immediately after visiting a doctor, the venous blood was collected and afterwards instantly the patient was given orally 300 mg of aspirin and 300 mg clopidogrel, and according to the patient's condition and the consent of his/her or acknowledgement of family members achieved, emergency percutaneous coronary interference (PCI) or thrombolysis or conservative treatment was adopted separately. After anti-thrombotic treatment, at 2, 4, 6, 8, 10, 12, 16, 20, 24, 32, 40, 48, 60 and 72 hours, venous blood was collected and serum isolated respectively. The concentration of 4 183Da DCD fragment in serum was determined by matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS). Simultaneously, the myoglobin (Myo), cardiac troponin I (cTnI) and MB isoenzyme of creatine kinase (CK-MB) were also detected.Results The mean relative strength of nature logarithmic transformations of 4 183Da DCD fragment of 118 patients with ACS was 2.75±1.02 before treatment on admission, and after intervention therapy (mainly antithrombotic therapy) it was decreased to 1.84±1.19 (P = 0.005) and 1.74±1.12 (P = 0.000) at 2 hours and 4 hours, respectively, and then after 4 hours it was slightly elevated. 4 183Da polypeptide increased earlier than myocardial injury markers.Conclusion Aspirin and clopidogrel can significantly decrease the concentration of 4 183Da DCD peptide fragment in serum in patients with ACS, which indicates that the DCD fragment could be used as one of the indexes for observation on early efficacy of antithrombotic therapy.

Background and purpose:Major repair genes that affect the tumor genetic susceptibility exists in repair pathways base excision repair (BER) approach, X-ray repair cross complementing group 1(XRCC1) gene, respectively is the core of BER pathway. At home and abroad in recent years, has carried out many studies of genetic polymorphism and laryngeal cancer susceptibility. Researching on the base excision repair (BER) pathway of DNA repair geneXRCC1 bases mononuclear nucleotide polymorphism and the relationship between different ethnic groups laryngeal cancer susceptibility in xinjiang.Methods:A case-control study was performed on 58 patient with laryngeal squamous cell carcinoma and 120 random healthy control group. Multiplex SNaPshot technic was used to detect DNA base excision repair geneXRCC1 Gln632Gln (rs3547), Arg399Gln (rs25487), Arg280His (rs25489), Arg194Trp (rs1799782) loci single nucleotide polymorphism distribution in the case group and normal control group.Results:Three sites of the rest of the cases ofXRCC1 Gln632Gln (rs3547) C/T (hybrid) and T/T (mutant) genotype, Arg399Gln (rs25487) C/T (hybrid) and T/T (mutant) genotype, Arg194Trp (rs1799782) G/A (hybrid) and A/A (mutant) genotype is notably higher than that of control group (P<0.01). Gln632Gln (rs3547) C/T (hybrid) and T/T (mutant) genotype, Arg399Gln (rs25487) C/T (hybrid) and T/T (mutant) genotype, Arg194Trp (rs1799782) G/A (hybrid) and A/A (mutant) genotype ratio is signiifcantly higher than control group (P<0.05) in cases of Han,Uygur and Kazakh nations, carrying (rs3547) C/T and T/T genotype, (rs25487) C/T and T/T genotype, (rs1799782) G/A and A/A genotype individual risk of laryngeal squamous cell carcinoma are added to the 0.96, 1.74 and 1.39 times; 1.47, 1.32 and 0.77 times; 1.49, 1.51 and 1.56 times thanXRCC1 (rs3547) C/C genotype, (rs25487) C/C genotype, (rs1799782) G/G genotype.Conclusion:In the 3 nations,XRCC1 Gln632Gln, Arg399Gln, Arg280His and Arg194Trp loci polymorphism may be associated with laryngeal cancer genetic and there are differences,XRCC1 Gln632Gln, Arg399Gln, Arg194Trp locus mutation will lead to an elevated risk of throat cancer.XRCC1 Arg280His locus mutation has no statistically signiifcant difference with the onset of throat cancer, may have nothing to do with the onset of laryngeal cancer on the site of mutation.

Objective To provide references for the plan-making of mental intervention on new recruits through the exploration of the comprehensive psychological behavior training influences on psychological stress and health and relevant factors.Methods 436 new recruits in training period were divided into comprehensive psychological behavior training group (intervention group) and non intervention group (control group).By randomly selected 2 (intervention group,control group) × 2 (Before training and after training) matching design,the questionnaire survey was carried out using stress-reaction questionnaire (SRQ),symptom checklist 90 (SCL-90),eysenck personality questionnaire(EPQ),trait coping style questionaire(TCSQ) at the 15th day and 75th day.t-test between group and matched t-test within group and multiple stepwise regression analysis were carried out.Results (1) The SCL-90 total point of new recruits in intervention group (125.26±36.52)and control group(124.92± 34.79) before the training and the difference of SRQ and TCSQ factor scores had no statistical significance(P＞ 0.05).The difference after the comprehensive psychological behavior training had no statistical significance (P＞ 0.05) as the total points of SCL-90 of intervention group(125.63±36.74) and other factors' score were compared with before.Except for the somatization and force,the total points of SCL-90 (131.21 ± 39.98)and other factor scores of the control group were all higher than what they were in the early period of the training significantly (P＜ 0.01 or P＜0.05).In the later period of group training,from the parallel controlled study among groups we found that except for the somatization and force,the total points of SCL-90 and other factor scores of the control group are all lower than the control group (P＜0.0 or P＜0.05).(2)The total points of intervention group's SCL-90 and SRQ had significant positive correlation with negative coping and stability(r=0.313-0.698,P＜0.01) while it had negative correlation with introversion and extroversion(r=-0.293--0.207,P＜0.01) as well as dissimulation at the later period of group training,however,it did not have significant correlation with positive coping method (P＞0.05).(3) The regression analysis showed that factors significantly affected the total score of SCL-90 respectively was:SRQ total score,negative coping method,stability,introversion-extroversion and psychoticism (P＜ 0.01).Five variables'coefficient of determination R 2 =0.665,F=247.82,P＜ 0.01.Conclusion The comprehensive psychological behavior training could reduce the over psychological stress of new recruits,promote their positive coping attitude and protecting their psychological health.Coping method and personality characteristics are important mediating variable between new recruits' psychological stress and mental health.

Objective To investigate the procedures and effects of surgical treatment for double disruption of the superior shoulder suspensory complex (SSSC).Methods Twenty-nine cases of double disruption of SSSC treated from January 2007 to October 2011 were enrolled in the study.There were 19 males and 10 females,at a mean age of 36 years (range,25-49 years).Injury causes included traffic injury in 25 cases and fall from height in 4.An open reduction and internal fixation was performed in 18 cases of scapular neck fracture combined with clavicular fracture,2 cases of scapular neck fracture combined with acromion fracture,2 cases of distal clavicular fracture combined with acromion and glenoid cavity fracture; hook plate fixation and ligament repair were performed in 3 cases of complete dislocation of acromioclavicular joint combined with complete disruption of coracoclavicular ligament ; open reduction and internal fixation and ligament repair were performed in 3 cases of scapular neck fracture combined with acromioclavicular joint dislocation and 1 case of clavicular fracture combined with coracoclavicular ligament disruption.Results All cases were followed up for a mean period of 11.5 months (range,6-30 months).Anatomic reduction of fractures was achieved for all cases and mean healing time was 8.4 weeks (range,7-12 weeks).Mean Constant-Murley score was 91 points (range,72-100 points),which indicated excellent results in 13 cases,good in 11,fair in 5,with excellence rate of 83％.ConclusionBased on the complex anatomic structure of the double disruption of SSSC,surgical management should focus mainly on respective fixation of the double injuries,which leads to good stability and therapeutic outcome.