Objective To study the clinical advantages of modified incision for PDA interruption under video-assisted thoracoscopy. Methods Sixty patients suffering PDA were operated on by the modified incision technique through the left subaxillary 3rd interspace 2.0cm-2.5cm mini-incision as manipulation incision and the front axillary line of the same interspace 0.4cm-1.0cm thoracoscope incision the operative difficulty required surgical time surgical field exposure,complications,postoperative pain and,cosmetic and surgical results were compared with those of the conventional PDA operation. Results The operation on the 60 cases were all successful.Actual intra-thoracic operation duration was (20.39?9.63)min.Due to the minor surgical trauma,the patients were able to ambulate two days after the surgery.Only eleven patients needed analgesia after the operation.Heart murmur completely disappeared postoperatively.No complications occurred.Postoperative echocardiogram showed no residual or recurrent shunt ,even in three years follow-up. Conclusions The modified incision for PDA interruption with the video-assisted thoracoscopy causes minim surgical trauma and is a safe and simplified surgical technique.

Objective To evaluate the role of routine delayed percutaneous coronary intervention (PCI) after thrombosis in the management of patients with ST-segment elevation myocardial infarction. Methods Ninety-eight patients with STEMI who underwent routine delayed PCI after thrombosis and other 82 patients with STEMI who were given conservative strategy after thrombolysis were enrolled in this study and were investigated during their in-hospital period and 6-month follow-up regarding major adverse clinical events (MACE) and the cardiac structure and function by echocardiography. The patients were divided into the control group (conservative strategy after thrombolysis), therapy group 1 (routine delayed PCI after successful thrombolysis), and therapy group 2 (routine delayed PCI after unsuccessful thrombolysis). Results Compared with conservative strategy after thrombolysis, routine delayed PCI after thrombosis decreased in-hospital mortality (4.9% vs 0%, 0%), shortened average hospital stay (25.3 days vs 13.5 days, 15.1days), decreased the need for revascularization for target lesion (7.3% vs 0%, 0%) and lowered the incidence of thrombosis or infarction (7.3% vs 0%, 0%), and also produced lower mortality (13.4% vs 1.4%, 0%), prevented reinfarction (12.2% vs 4.2%, 4.5%) and stroke (2.4% vs 0%, 0%), decreased the need for revascularization for target lesion (28% vs 4.2%, 4.5%) and prevented further left ventricle remodling. Conclusion Routine delayed PCI after thrombosis may to prevent recurrent ischemia, reinfarction, and reocclusion, so as to improve immediate results and 6-month prognosis.

Objective To investigate effects of dynamic hip screw (DHS) fixation assisted with blocking screws in treatment of intertrochanteric fracture.Methods A total of 150 patients with intertrochanteric fracture were selected as the combined treatment group,of which the patients managed by DHS intemal fixation were followed by the parallel placement of a blocking screw closely beneath the main screw for stability with its end rested on the plate.Another 87 patients managed by DHS fixation alone were determined as the control group.The surgical outcomes of the two groups were analyzed and compared.Results Good fixation without external displacement of femoral neck and cut-out of the main screw in femoral head was achieved in the combined treatment group.Also,fracture nonunion or death did not exist in the combined group.The patients in combined treatment group could take care of themselves after operation in the absence of severe pain and functional disturbance,with higher excellence rate (98.7％)than that in control group (P ＜ 0.01).Whereas,the operation failure rate was significantly lower in combined treatment group than in control group (P ＜ 0.05).Conclusion DHS fixation assisted with blocking screws is an ideal treatment of incomplete intertrochanteric fracture in medial wall of calcar femorale for it can achieve reliable fixation and definite curative effect,favor fracture healing,early functional exercise and low incidence of postoperative complications.

Objective To investigate the effect of posterior pedicle screw reduction and fixation,decompressive laminectomy and massive autogenous bone grafting using bone particles harvested from resected vertebral body in treatment of lumbar spondylolisthesis.Methods Fifty-six cases of lumbar spondylolisthesis treated from June 2005 and June 2006 were reviewed retrospectively.According to Meyerding classification,35 cases were classified as grade Ⅰslippage and 21 cases as grade Ⅱ slippage.There were 19 spondylolisthesis at L4/5 and 37 at L5-S1.After posterior pedicle screw reduction and fixation,decompressive laminectomy and massive autologous bone grafting using particles of resected vertebral body,surgical outcome was analyzed.Results All cases achieved bone fusion without evidence of nail breakage or nerve injury.According to Macrab criteria,the results were excellent in 53 cases and good in three.Moreover,both the full reduction rate and interbody fusion rate were 100％.Conclusion Posterior pedicle screw reduction and fixation,decompressive laminectomy plus massive autogenous bone grafting is one of the ideal treatments for lumbar spondylolisthesis,for it achieves satisfactory fixation,decompression,reduction and fusion.

Objective To investigate the nursing methods of transferring peduncle island skin flap in foot. Methods Nursing about 19 patients who have undergone the transferring of peduncle island skin flaps because of soft tissue injury in foot. The preoperative nursing included skin nursing, individual psycho-behavior guidance, room allocation. Postoperative nursing included placement of limbs correctly, nursing about the transferring district flaps, observation and nursing the vescular crisis, correct using anticoagulant and functional exercises of ankle-joint. Results There were 18 flaps survived completely, 1 flaps in distal end had partly necrosis, but flap had recovered well afterⅡ-period skin grafting. Conclusion Overall elaborate clinical nursing can guarantee the survival of the graft peduncle island skin flaps in foot.

Background The imbalance of cell cycle regulation results in proliferative vitreoretinopathy (PVR).Studing the effects of cyclin dependent kinase (CDK) and CDK inhibitor (CKI) on the cell cycle regulation of retinal pigment epithelial (RPE) cells and fibroblasts in PVR formation is of important significance.Objective This study was to investigate the expressing trend of p21 ,p27 and CDK inhibitors in retinas of different ages of rabbits and explore the relationship between p21 or p27 and cell growth.Methods Nine clean New Zealand rabbits were assigned to 10-week group,20-week group and 30-week group according to the age and 3 rabbits for each.The eyeballs were enucleated binocularly after the animals were sacrificed and retinas were isolated.Real-time PCR and Western blot were employed to detect the expressions of p21 and p27 mRNA and their proteins in retinas of the rabbits.The use and care of the animals followed the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Committee.Results The relative expressing levels of p21 mRNA were 1.631±0.063,1.506±0.012 and 1.585 ±0.015, and those of p27 m RNA were 1.581 ± 0.048,1.470 ± 0.012 and 1.490 ±0.013 in the 10-week group,20-week group and 30-week group, respectively, showing significant differences among the groups (p21 mRNA: F=9.311,P=0.014;p27 mRNA: F=12.360, P=0.007) , and the p21 and p27 mRNA expressing levels were significantly higher in the 10-week group and 30-week group than those in the 20-week group (all at P＜ 0.05).The expressing levels of p21 protein were 0.675 ± 0.061,0.089 ±0.001 and 0.200 ± 0.007, and those of p27 protein were 0.928±0.019,0.183±0.005 and 0.576±0.089 in the 10-week group,20-week group and 30-week group, respectively, with remarkable differences among the groups (p21 : F =228.905, P＜0.001;p27 : F =148.957,P＜0.001), and the expressions were significantly raised in the 10-week group and 30-week group in comparison with the 20-week group (all at P＜0.01).Significantly positive correlations were found in the expressing levels of p21 and p27 both in transcriptional and protein levels (mRNA : r =0.906, P＜0.01;protein : r =0.913, P＜0.01).Conclusions The expressions of p21 and p27 up-regulate in the retinas of developing stage of rabbits but gradually reduce with adultness.However, p21 and p27 levels appear to be increasingly raised with aging of the rabbits.It is implied that p21 and p27 play a balancing role in the process of cycle regulation in retina cells.

BACKGROUND:The distal tibia shaft fracture is prone to be comminuted after trauma due to the absence of muscle covering and the thin soft tissue, and intraoperative reduction and fixation are difficult. Clinical efficacy is closely related to the type of fracture, degree of soft tissue injury, choice of therapy and internal fixation. Internal fixation is the main treatment for the distal tibia shaft fracture, and a microinvasive, strong fixation is the focus of tibial fracture treatment although many methods for internal fixation are present. ＜br> OBJECTIVE:To explore clinical efficacy of the treatment of distal tibia shaft fracture using percutaneous locking compression plate, interlocking intramedul ary nail and open reduction with internal fixation. ＜br> METHODS:A total of 180 patients with distal tibia shaft fracture were randomized into three groups, receiving internal fixation treatment using percutaneous locking compression plate, interlocking intramedul ary nail or open reduction. Al patients were fol owed up for 12-24 months. The clinical outcomes of the treated patients in three ＜br> groups were compared through the observations of incision length, operation time, intraoperative fluoroscopy time, intraoperative blood loss, complications after fixation. ＜br> RESULTS AND CONCLUSION:After excluding the loss of fol ow-up, 56 cases receiving percutaneous locking compression plate, 52 cases receiving interlocking intramedul ary nail and 48 cases receiving open reduction were involved in the final analysis. The incision length and intraoperative blood loss in the groups of percutaneous locking compression plate and interlocking intramedul ary nail were significantly better than that of open reduction (P＜0.05). Intraoperative fluoroscopy time in the group of percutaneous locking compression plate was significantly longer than that in other two groups (P＜0.05). The operation time showed no significant differences among three groups. The rate of complications was 11%in the group of percutaneous locking compression plate, and 27%in the groups of interlocking intramedul ary nail and open reduction with internal fixation. Percutaneous locking compression plate is a good choice for the distal tibia shaft fracture due to smal injury, good biomechanical stability, and no influence on blood supply at fracture end;interlocking intramedul ary nail is also a useful technique due to simple operations. Open reduction with internal fixation should be chosen careful y due to great dissection, great influence on blood supply and high complication rate.

Objective To study the alteration of hepatocyte growth factor and c-met in the lungs of rats with pulmonary arterial hypertension and its possible underlying mechanisms.Methods Left pneumonectomy plus monocrotaline injection was used for rat PAH model.Rats were executed after measurement of their pulmonary arterial pressure at 1,2, 3 and 4 weeks after MCT injection.Then the right lung and heart were harvested for further analyses.Expression of HGF and c-met was determined by RT-PCR and Western blot.Expression of eNOS and caspase-3 was analyzed immunohistochemically and intrapulmonary TGF-β and ET-1 was analyzed with ELISA.Results Compared with the normal controls, manifestations of right heart hypertrophy and failure, well-elevated pulmonary arterial pressure were observed 28 days after left lung resection and MCT injection.Pulmonary vascular remodeling (i.e., pulmonary fibrosis, hyperplasia of pulmonary arterial endothelial cells and vascular smooth muscle cells in tunica media, as well as decease of vascular density) was observed.Intrapulmonary HGF expression decreased in a time-dependent manner at both mRNA and protein levels 4 weeks after MCT injection, while c-met stayed unchanged.Immunohistochemically, expression of eNOS was reduced and caspase-3 strengthened.On the contrary, ET-1 and TGF-β were obviously up-regulated(P ＜ 0.01).Conclusion Intrapulmonary HGF expression was obviously downregulated in PAH rats, accompanying with reduction of NO and increase of ET-1 and TGF-β expression, while c-met still unchanged.

Objective To investigate the structural and functional changes of lower motor neuron distal to the site of spinal cord injury in rats. Methods Seventies Sprague-Dawley rats were divided randomly into 6 groups: sham-operation group (controls, n=10) and 3 day group (n=10), 1 week group (n=10), 2 week group (n=10), 4 week group (n=15) and 8 week group (n=15) after spinal cord transaction at T10. Neuronal apoptosis and acetylcholinesterase (AChE) activity of spinal cord at L4- 6 were observed by using the terminal deoxynucleotidal transferase- mediated DUTP-biotin nick end labeling (TUNEL) method and the semiquantitative enzyme cytochemistry, respectively. Results The assessment of apoptosis by TUNEL labeling showed that fluorescent markers were observed occasionally in anterior horn distal to the site of injury. The optical density (OD) value of AchE positive motor neurons (area > 300 μm2) initially decreased about 3 days after transaction and then overshot 1 week or so. However, after that, the OD value decreased again, the lowest about 4 weeks. Then the OD value increased again, though at 8 weeks was still lower than that of controls (P<0.05). Conclusion The findings on indistinctive apoptosis provided the proof of no significant changes of lower motor neuron distal to the site of transection. Semiquantitative histochemical results about AChE reflected marked metabolic changes of motoneurons caudal to the transaction, which represented as part of functional reorganization.

ObjectiveTo evaluate the accuracy of measurement of left ventricular(LV) volume and function in coronary heart disease(CHD) by real-time three-dimensional echocardiography(RT-3DE) using cardiac magnetic resonance imaging (CMRI).Methods LV end diastolic volume(EDV),LV end systolic volume(ESV) and LV ejection fraction(EF) were measured with RT-3DE in patients with CHD ( n =37) and in the control ( n =30).The results measured by RT 3DE were compared with those of CMRI.The diagnostic value of RT-3DE was evaluated using receiver operating characteristic(ROC) curve.Results Compared with that measured by CMRI,EDV,ESV and EF by RT 3DE( P ＞0.05) were almost similar as that in the control.Area under ROC curve of in EDV and ESV were 0.912 and 0.944 in the control.However,EDV determined by RT-3DE was smaller than that by CMRI( P ＜0.05) in CHD group.A difference (10.95 ± 31.26 ml) was existed in EDV between the two methods.ESV measured by RT-3DE was smaller than that calculated by CMRI( P ＞0.05) with a mean differance of (3.17 ± 16.42)ml in CHD group.EF by RT-3DE( P ＞0.05)was almost as same as that by CMRI in CHD group,with a mean difference of (1.54 ± 11.85)％.The area under ROC curve of EDV and ESV were 0.834 and 0.873 in CHD group and their diagnostic performance was moderate.ConclusionsMeasurment of LV volume and function by RT 3DE in control was more acurrate than that in CHD.In the cases of LV remodeling in patients with CHD,RT-3DE would underestimate the LV volume.