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.

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.

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

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.

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。

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

The study reports the detection of neuroprotective effect of 10 kinds of coumarin derivatives and explores their possible mechanism. MTT method was used to screen the neuroprotective effect of 10 coumarin derivatives on neurotoxic agents (Aβ25-35 and rotenone) or OGD (oxygen-glucose deprivation). A compound with better protective effect was obtained. Then the effect of this compound on neurotoxic agents on PC12 was detected by the morphological observation. Furthermore, the effect of compound 3 on microglia with lipopolysaccharide (LPS) induced inflammation was detected. And the inflammatory factor was tested. Finally, direct free radical scavenging ability was detected. Compound 3 was found to be the best compound through three neurons toxic models. Not only compound 3 ameliorated cell viability reduced by three neurons toxic models, but also significantly inhibited the production of inflammatory factor (TNF-α and IL-1β). And its free radical scavenging ability is very good, especially the effect on superoxide anion, which is comparable with vitamin C. The significant scavenging effect of compound 3 on superoxide anion might be the mechanism of the neuroprotection. Compound 3 as a potential neural cell protective agent merits further investigation.
Animals ; Coumarins ; chemistry ; Free Radical Scavengers ; chemistry ; Inflammation ; Microglia ; drug effects ; Neurons ; drug effects ; Neuroprotective Agents ; chemistry ; PC12 Cells ; Rats

Objective To summarize our experience in endovascular repair of 83 cases with type B aortic dissection.Methods A retrospective analysis was performed in 83 cases of type B aortic dissections who were treated in our hospital.Results The surgical procedure was successful for all the patients.Two patients died peri-operatively.One case encountered a coma,but no post-operative paraplegia occurred.Conclusion Endovascular repair for type B aortic dissection is a micro-invasive,safe and effective technique.Long-term follow-up is required to give a comprehensive evaluation.

Objective To describe the treatment experience of post-operative complications after total arch replacement for acute type A aortic dissection in 34 cases.Methods The subjects were 34 consecutive patients (Twenty-eight males and 6 females,age 34.0 -60.0 yrs) who received total arch replacement for acute Stanford type A aortic dissection from Jan.2005 to Oct.2010 in our hospital.The duration from the onset of the symptoms to the hospitalization ranged from 4 - 18 hrs.Pre-operative 2-D Echo revealed aortic valve regurgitation in 8 patients and mitral valve regurgitation in 1 patient.Results Three patients died after operation ( mortality 8.8％ ).Severe complications included acute kidney injury in 13 cases,respiratory dysfunction in 12 cases,paraplegia in 1 case,mental disorder in 10 cases and excessive post-operative bleeding in 2 cases.Conclusion The incidence of the complications after total arch replacement is still high and severe.Intensive care should be stressed peri-operatively and early diagnosis and treatment for post-operative complications are important procedures.

Objective To evaluate the clinical significance of the change of serum matrix metalloproteinases (MMP)-1,-2,-3 and -9 in acute and chronic aortic diseases and acute myocardial ischemia.Methods The blood serum levels of MMP-1,-2,-3 and -9 were detected in 30 patients with acute aortic dissection,19 patients with chronic aortic dissection,19 patients with aortic aneurysm and in 12 patients with acute myocardial ischemia,as well as in 16 healthy individuals who served as the control group.Serum MMP levels were measured by using an ELISA technique.Results There were significantly higher levels of MMP-3 in patients with acute myocardial ischemia as compared to acute aortic dissection ( [19.10 ± 3.11 ] μg/L vs [11.89 ± 1.31 ] μg/L,P =0.02).Significantly lower levels of MMP-1 were found in healthy controls compared to the groups of patients ( [1.30 ± 0.56 ] μg/L vs [2.99 ± 0.78 ] μg/L in acute aortic dissection,P =0.03,[3.12 ±0.78] μg/L in chronic dissection,P =0.02,[3.01 ± 1.01 ] μg/L in thoracic aortic aneurysm,P =0.03 and [5.01 ± 0.98 ] μg/L in acute myocardial ischemia,P =0.01 ).Higher levels of M MP-1 and MMP-3 were detected on males.There was a positive correlation between MMP-1 and increasing age ( r =0.38,P ＜ 0.05 ).In patients operated for acute type A aortic dissection,the levels of MMP-1,MMP-3 and MMP-9 increased immediately after surgery,while the levels of MMP-2 decreased.Twenty-four hours after surgery levels of MMP-1,-2 and -9 were almost equal to the preoperative ones( P ＞ 0.05 ).Conclusion Measurement of serum MMP levels in thoracic aortic disease and acute myocardial ischemia is a simple and relatively rapid laboratory test that could be used as a biochemical indicator of aortic disease or acute myocardial ischemia,when evaluated in combination with imaging techniques.