Objective: To explore the application value of ablation catheter for pacemaker atrial lead restoration in relevant patients.
Methods: A total of 6 patients with atrial lead dislodgement after pacemaker implantation were selected for our study. The atrial lead restoration was conducted by using ablation catheter via femoral vein pathway.
Results: The average operational time was (15.0 ± 3.7) min which was obviously less than traditional operational time. The position of electrode restoration was ideal with well immobilization.
Conclusion: Ablation catheter is feasible for arial lead restoration in patients with atrial lead dislodgement after pacemaker implantation.

Objective To explore the relationship between plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and the location and prognosis of acute ST-segment elevation myocardial infarction (STEMI) in elderly people.Methods From May 2012 to April 2014, the 137 elderly patients (aged≥60 years) with acute STEMI within 24 h after symptoms onset admitted in cardiovascular department of Ningbo First Hospital were selected as acute myocardial infarction group (AMI group), and 40 elderly healthy people (age≥60 years) as control group.The plasma NT-proBNP levels were detected by enzyme linked immunosorbent assay(ELISA), and compared between the two groups.The patients in AMI group were classified into four subgroups: anterior AMI group (A group, n=44), anterolateral AMI group (B group, n=21), anterior septal AMI group (C group,n=18) and inferior AMI group (D group, n=54), and the changes of plasma NT-proBNP levels in different infarction location were explored.Meanwhile, all patients were followed up for 30 days and 1 year to observe major adverse cardiac events (MACEs) and mortality rate, then to explore the relationship between plasma NT-proBNP level and prognosis in elderly people with STEMI.Results The plasma NT-proBNP levels were significantly higher in AMI group than in control group [(1 406.2±1 322.5)ng/L vs.(63.7±18.5) ng/L, P＜0.01].The changes of plasma NT-proBNP levels in high-to-low sequence were from A group to B group to C group to D group and to control group (P＜0.05).At 30 days, the plasma NT-proBNP levels were higher in death group than in survival group (P＜0.05), and were higher in MACE group than in non-MACE group (P＜0.05).At one year, there were no significant differences in plasma NT-proBNP levels between death group and survival group (P＞0.05), and the plasma NT-proBNP levels were higher in MACE group than in non-MACE group (P＜0.05).Conclusions In elderly STEMI patients, there is a correlation between plasma NT-proBNP levels and infarct location, with the highest NT-proBNP level in anterior AMI.The plasma NT-proBNP level could predict MACE.

Objective To study the effects of tyrosine kinase receptor B-brain-derived neurotrophic factor (TrkB-BDNF) signal pathway on the secretion of vascular endothelial growth factor (VEGF) and matrix metalloproteinases-9(MMP-9) of neuroblastoma.Methods We used all-trans retinoic acid (ATRA) to induce the high expression of TrkB in the SH-SY5Y cell line,and then added the ectogenid BDNF to activate the TrkB-BDNF and its three downstream signal pathways.TrkB-BDNF signal pathway was inhibited by specific tyrosine kinase inhibitor K252a.The three downstream signal pathway was respectively inhibited by LY294002 (the phosphatidylinositol 3-hydroxy kinase (PI3 K) pathway inhibitor)、U73122 (the phospholipase C pathway inhibitor) 、U0126(the mitogen activated protein kinase pathway inhibitor).Enzyme linked immunosorbent assay was used to detect the concentration of VEGF and MMP-9 protein in the SY5Y cell culture supernatants.Results VEGF [(485.89 ± 109.99) pg/ml] and MMP-9 [(15.73 ± 1.72) pg/ml] protein levels in neuroblastoma cells cultured in serum-free media in the group of ATRA + BDNF were significantly higher than that of the control group and ATRA alone group(P ＜0.05).VEGF [(272.42 ±86.33) pg/ml]and MMP-9 [(5.25 ± 1.44) pg/ml] protein levels in the group of ATRA + BDNF + K252a were significantly lower than those of the ATRA + BDNF group(P ＜ 0.05) and had no significant difference compared with the control group and the ATRA alone group(P ＞0.05).VEGF [(314.12 ±24.68) pg/ml] and MMP-9 [(4.91 ± 1.08) pg/ml] protein levels in the group of ATRA + BDNF + LY294002 were significantly lower than those of the ATRA + BDNF group(P ＜ 0.05) and had no significant difference compared with the control group and the ATRA alone group(P ＞0.05).VEGF [(444.08 ±64.49) pg/ml] and MMP-9 [(13.28 ±3.38) pg/ml] protein levels in neuroblastoma cells cultured in serum-free media in the group of ATRA +BDNF + U73122 had no significant difference compared with the ATRA + BDNF group(P ＞ 0.05).VEGF [(429.97 ± 19.95) pg/ml] and MMP-9 [(13.96 ± 4.45) pg/ml] protein levels in neuroblastoma cells cultured in serum-free media in the group of ATRA + BDNF + U0126 had no significant difference compared with the ATRA + BDNF group(P ＞ 0.05).Conclusion Activation of TrkB-BDNF signal pathway can increase the synthesis and secretion of VEGF and MMP-9 in human neuroblastoma cells.TrkB-BDNF signal pathway may be through activating its downstream PI3K pathway to increase the synthesis and secretion of VEGF and MMP-9 in human neuroblastoma cells.The synthesis and secretion of VEGF and MMP-9 can be inhibited by blocking the TrkB-BDNF signal pathway with K252a or blocking its downstream signal pathway PI3 K with LY294002.

Apolipoprotein C3 (APOC3) is a multifunctional protein.Its concentration is positively correlated with triglyceride (TG) levels and is an independent risk factor for coronary heart disease (CAD) prediction and development.Recent studies showed that APOC3 could not only regulate triglyceride-rich lipoproteins (TRL) metabolism,but also regulated endothelial function,that is,it could induce endothelial dysfunction and disorders of lipid metabolism.Gradually,APOC3 induces atherosclerosis (AS),increases the risk of the occurrence of CAD and other related diseases.APOC3 polymorphisms are also closely related to related diseases.

Objective To compare HC video-laryngoscope with Macintosh laryngoscope for tracheal intubation.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index 19-27 kg/m2,Mallampati grade Ⅰ-Ⅱ,undergoing elective surgery,were randomly divided into 2 groups (n =30 each):HC video-laryngoscope group (group H) and Macintosh laryngoscope (group M).After induction of anesthesia,the patients underwent orotracheal intubation assisted by HC video-laryngoscope in group H,and by Macintosh laryngoscope in group M.The glottic exposure time,intubation time,Cormack-Lehane grade,the number of pressing the cricoid and intubation-related complications were recorded.Results The rate of satisfactory glottic exposure was significantly higher and the number of pressing the cricoid was smaller in group H than in group M (P ＜ 0.05).There was no significant difference in the glottic exposure time,intubation time and incidence of intubation-related complications between the two groups (P ＞ 0.05).Conclusion The efficacy of tracheal intubation guided by HC video-laryngoscope is better than that guided by Macintosh laryngoscope.

BACKGROUND: Chitosan is one of the most significant non-viral vector materials with the advantages of outstanding biocompatibility. Quarternary chitosan derivatives can improve transfection efficiency and solubility of chitosan in a broader range of pH values. OBJECTIVE: To synthesize a new vector of quarternary chitosan and to study its complex conditions with plasmid and transfection efficiency compared with chitosan. DESIGN, TIME AND SETTING: A contrast observational study was performed in Second Affiliated Hospital of School of Medicine of Zhejiang University between August and October 2008. MATERIALS: Quarternary chitosan was synthesized in Polymer Materials Lab of Beijing Institute of Technology. Plasmid pEGFP-C1 was presented friendly by Mr. Zheng of School of Medicine of Zhejiang University. Hela cells were provided by Miss. Cheng of School of Medicine of Zhejiang University. METHODS: Quarternary chitosan was prepared according to mass concentration of 0.2 g/L, pH value 5.5 (or 6.9, 7.6) and sodium acetate concentration of 50 mmol/L, and rapidly mixed with pEGFP-C1. The mixture was swirled for 15-30 second and stood at room temperature for 30 minutes at least. MAIN OUTCOME MEASURES: The impacts of pH values and time on complex ability of quarternary chitosan and plasmid were studied by gel retardation test. Transfection efficiency of quarternary chitosan on Hela cells was observed by inversed fluorescence microscope and also compared with chitosan. RESULTS: Quarternaty chitosan could form complex with plasmid in acidic, neutral and basic conditions. It could be used in a broader range of pH values. In an acidic condition, the combination of quarternary chitosan with plasmid was superior to chitosan. A stable complex was formed via a combination of quarternary chitosan or chitosan with plasmid within 30 minutes, and the stability lasted for 12 hours. Transfection efficiency of quarternary chitosan on Hela cells demonstrated that transfection efficiency of quarternary chitosan was superior to chitosan. CONCLUSION: Quarternary chitosan has a broader range in use and higher transfection efficiency than chitosan; however, there is no significant difference in stability between quarternary chitosan and chitosan. Additionally, transfection efficiency of quarternary chitosan on Hela cells is superior to chitosan, which needs a further research.

Objective To evaluate the role of real-time three-dimensional transesophageal echocardiography(RT-3D TEE)in left atrial appendage (LAA)occlusion.Methods Consecutive 10 atrial fibrillation (AF)patients (CHADS2 ≥ 2 )with high risk bleeding underwent LAA occlusion under the guidance of TEE.The LAA orifice shape and characteristics of lobes were assessed,the size of LAA with RT-3D TEE wee measured before closer implanation,and the position of the LAA occlusion device were evaluated by RT-3D TEE.The correlational analysis between LAA diameter and occluder size was conducted.Results Among 10 patients,the test results revealed 8 cases with complete LAA occlusion and 1 case with incomplete occlusion,and 1 case with failed occlusion.Five cases showed approximate round LAA ostium,and the other 5 showed approximate oval ostium.The average number of LAA lobes were 2.2±0.7. LAA ostium long diameter were larger by 3D TEE compared with 2D TEE[(21 .8±5.1)mm vs (20.8±4.1) mm],and ostium short diameter were smaller by 3D TEE compared with 2D TEE [(16.1 ± 3.0 )mm vs (1 7.0±2.6)mm],however there were no significant differences between 2D and 3D TEE measurements,and the mean ostium diameter and LAA depth were comparable between two methods.LAA ostium long diameter,short diameter,average diameter and LAA depth assessed by 3D TEE and 2D TEE showed good correlation with occluder diameter (3D TEE:r =0.719,0.690,0.791 ,0.71 1 ,and P =0.029,0.040,0.01 1 , 0.032,respectively;2D TEE:r = 0.887,0.894,0.932,0.896,and P = 0.001 ,0.001 ,0.000,0.000, respectively).LAA occlusion device position assessed by RT-3D:6 cases with appropriate position, acceptable position with 2 cases,and 1 case with malposition.Conclusions RT-3D TEE can play important role in evaluating the morphology of LAA,accurately judging LAA ostium shape and size and position of the occlusion device.

Objective To compare the dosimetric differences between two plans of RapidArc and 5F-IMRT for breast cancer radiotherapy after breast-conserving surgery.Methods Eight female patients with left-sided breast cancer after breast-conserving surgery were selected.A dose of 50 Gy in 25 fractions was prescribed for plans of RapidArc and 5F-IMRT.Target conformity index (CI),homogeneity index (HI),target coverage,exposure dose volume delivered to organ at risk were compared between two plans.At the same time,treatment delivery time and monitor units (MU) were also compared.Results The target conformity index (CI) in RapidArc plan (·0.88 ±0.03) was higher than that in 5F-IMRT plan (0.79 ±0.02,t =8.28,P ＜ 0.05).The homogeneity index (HI) in RapidArc plan 9.01 ± 0.73 was significantly lower than that in 5F-IMRT plan10.44 ± 1.08 (t =-2.73,P ＜0.05).For the dose volume delivered to the ipsilateral lung in two plans,the values of V10,V20,V30,and Dmean in RapidArc plan were lower than those in 5F-IMRT plan(t =-7.53,-7.20,-8.39,-7.80,P ＜ 0.05).However,the value of V5 in RapidArc plan was higher than that in 5F-IMRT plan (t =5.67,P ＜0.05).For the heart,the values of V5,V10 and Dmean in RapidArc plan were higher than those in IMRT plan(t =10.46,28.76,5.40,P ＜ 0.05),while the value of V30 in RapidArc plan was lower than that in 5F-IMRT plan(t =-6.12,P ＜0.05).The values of V5 in contralateral lung and breast were higher in RapidArc plan than those in 5F-IMRT plan(lung:t =21.50,P ＜0.05;breast:t =5.44,P ＜0.05).The MU in RapidArc plan was decreased by 25％,and the average treatment delivery time was saved by 60％,compared with that of 5F-IMRT plan.Conclusions During breast cancer radiotherapy after breast-conserving surgery,compared with 5F-IMRT plan,the RapidArc plan could improve the target HI,and reduce both the irradiated dose in high-dose volume and MU,and shorten the treatment time,but increased the exposed volume in low-dose volume of normal tissues.

Objective To investigate the feasibility and potential advantages of RapidArc applied to the radiotherapy of the postoperative rectal cancer.Methods 8 postoperative patients with rectal cancer were selected to be treated with a dose of 50Gy in fraction of 2Gy every time and 5 times a week.IMRT and RapidArc were used respectively to compare different target conformities,homogeneity index,dose-volume histogram data,treatment times and monitor units.Results The conformal index by RapidArc was 0.89±0.02 which was better than those by 5F-IMRT,0.87±0.02 (t =3.286,P ＜ 0.05),while the homogeneity index of target volume (1.060±0.005) and average dose [(52.55±0.76) Gy] by RapidArc were a little less than the homogeneity index of target volume (1.064±0.007) and average dose [(52.90±0.82) Gy] by 5F-IMRT (t =-1.459,-1.000,P ＞ 0.05).The exposure dose and mean dose of bladder and small bowel in high dose region by RapidArc were lower than those by 5F-IMRT,as well as bone marrow.The differences were statistical significant (P ＜ 0.05).The monitor units by RapidArc and by 5F-IMRT were (631±68) MU and (1046±146) MU,respectively (t =-5.830,P ＜ 0.05),while the mean treatment times were (78±5) s and (348±29) s,respectively (t =-26.358,P ＜ 0.05).Conclusion Compared with 5F-IMRT,RapidArc improves the target conformities and lowers the exposure dose for the organs at risk in high dose region while using fewer monitor units and less treatment time,which helps comforting patients and improving the efficiency.

Objective To investigate the enhancing effect of apolipoprotein C3 (APOC3) on THP-1 cell adhesion to aortas of mice.Methods Microsurgery was performed to separate the aorta of C57BL/6 mice in sterile condition.After stimulated by APOC3 (100 △g/ml) in vitro for 16 h,the aorta was allowed to adhere for 1 h with CFSE labeled THP-1 cells (1 ×106/ml).Then the adhesion effect was observed,and the expressions of vascular adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1) were detected by immunohistochemical method.Results Adhesion effect of the mice aorta with THP-1 cells in the APOC3 stimulated group was stronger than the control group.Both the expressions of VCAM-1 and ICAM-1 in aortas were increased by APOC3,but the former was significantly up-regulated than the latter.Conclusion Apolipoprotein C3 could enhance THP-1 cell adhesion to aortas of mice.