Objective To evaluate the effects of cardiac resynchronization therapy with optimized dynamic AV delay.Methods The study included 63 patients who underwent implantation of biventricular pacemakers for congestive heart failure.The dynamic AV delay was optimized on the day 1 week,6 months and 12 months after pacemaker implantation.The echocardiography and ECG,6MHW,QOL and NYHA grade were evaluated at the same time.Results The best optimized AV delay was between 90 ms and 140 ms(110.45?19.47 ms).Comparing the effectiveness 1 week after CRT with the day before CRT:the LVEF increased from 18.53%?4.83% to 22.07%?6.77% with the QRS interval decreased from 138.25?28.00 ms to 129.40?6.65 ms.Comparing the effectiveness of the day before and in 6-12 months after CRT optimized AV delay,the LVFT increased from 293.27?24.79 ms to 347.57?26.21 ms.There was no difference in QRS intervals.The LVEDD was upgraded from 71.43?7.12 mm to 57.06?6.54 mm while the QOL was upgraded from 74.14?6.24 to 55.15?11.02 and the NHYA upgraded from 3.12?0.55 to 1.82?0.43.Conclusion Optimized dynamic AV delay of the pacemaker parameters enhanced the short-term and long-term efficacy of CRT.

Objective To study the safety and efficacy of laparoscopic splenectomy and portoazygous devascularization for portal hyperteation.Methods The data of 58 patients who underwent laparoscopic splenectomy and portoazygous devascularization were retrospectively collected and analyzed.Results The operative time for laparoscopic splenectomy and portoazygous devascularization was (2.6 ±0.6) hours.The intraoperative bleeding was (149.5 ± 32.7) ml.The time taken for the bowel to return function was 3.5 ±1.3 days.The hospitalization time was (5.1 ± 1.2) days.When the splenic volume was greater than or equal to 1.5 liters, the conversion to open surgery rate significantly increased [36.0％ (5/14);P ＜ 0.05].The 1, 2, 3, and 4 years cumulative recurrent gastrointestinal bleeding rates were 0, 5.2％, 10.0％, and 15.8％, respectively.Conclusions Laparoscopic splenectomy and pericardial devascularization was safe, efficacious and feasible.When the splenic volume was greater than 1.5 L, whether laparoscopic surgery should be attempted requires further research.

ObjectiveTo investigate the features of pulmonary function and influencing factors in patients with cervical spinal cord injury (SCI).MethodsThe pulmonary function data of 48 patients with cervical SCI were analyzed. The correlations between the percent predicted values of vital capacity (VC), maximal voluntary ventilation (MVV), forced expiratory volume of 1st second (FEV1) and V75 (expressed as VC%, MVV%, FEV1%, V75%) and ASIA motor/sensory scores were analyzed. Then, four multiple linear regressions were run to use VC, MVV, FEV1, V75 as an independent variable respectively.ResultsThe percent predicted values of the pulmonary function (VC%, MVV%, FEV1%, V75%) in patients with cervical SCI obviously decreased, which suggested that these patients had a restrictive ventilation disorder. There were significant positive correlations between VC%、FEV1%、V75% and ASIA motor scores (by bivariate correlation tests), no significant correlations between any of pulmonary function parameters and the ASIA sensory scores. Of four linear regression models, the height showed as a protecting factor in 3 linear regression models and weight did in the other one respectively. Of parameters associated with SCI, just ASIA motor scores showed as a protecting factor in 3 linear regression models, no sensory scores or duration appeared in any linear regression models.ConclusionBesides the height and weight, the ASIA motor score is a main factor influencing the pulmonary function.

The aim of this work was to investigate guar gum/ethylcellulose mix coated pellets for potential colon-specific drug delivery. The coated pellets, containing 5-fluorouracil as a model drug, were prepared in a fluidized bed coater by spraying the aqueous/ethanol dispersion mixture of guar gum and ethylcellulose. The lag time of drug release and release rate were adjustable by changing the ratio of guar gum to ethylcellulose and coat weight gain. In order to find the optimal coating formulation that was able to achieve drug targeting to the colon, the effect of two independent variables (the ratio of guar gum to ethylcellulose and the coat weight gain) on drug release characteristics was studied using 3×4 factorial design and response surface methodology. Results indicated that drug release rate decreased as the proportion of ethylcellulose in the hybrid coat and the coat weight gain increased. When the ratio of guar gum to ethylcellulose was kept in the range of 0.2 to 0.7, and the coat weight gain in the range of 250% to 500%, the coated pellets can keep intact for about 5 h in upper gastrointestine and achieve colon-specific drug delivery. The pellets prepared under optimal conditions resulted in delayed-release sigmoidal patterns with T5% (time for 5% drug release) of 5.1-7.8 h and T90% (time for 90% drug release) of 9.8-16.3 h. Further more, drug release was accelerated and T90% of the optimum formulation pellets decreased to 9.0-14.5 h in pH 6.5 phosphate buffer with hydrolase. It is concluded that mixed coating of guar gum and ethylcellulose is able to provide protection of the drug load in the upper gastrointestinal tract, while allowing enzymatic breakdown of the hybrid coat to release the drug load in the colon.

Objective To assess the effects of fluvastatin retard tablets on the elder patients of acute coronary syndrome(ACS) complicated with diabetes mellitus(DM) undergoing percutaneous coronary intervention (PCI) and the safety of drugs.Methods From December 2009 to December 2011,78 elderly patients (age≥65 years) of ACS complicated with DM who underwent PCI were enrolled in this study.They were all treated by drug elution stents.They were divided into group A(fluvastatin retard tablets 80 mg/d) and group B (fluvastatin retard tablets 160 mg/d) with 39 cases each by random digits table method.The plasma levels of high sensitivity C reactive protein (hs-CRP),matrix metalloproteinase proteinase 9 (MMP-9),monocyte chemoattractant protein 1 (MCP-1) and lipid levels were measured before and after treatment of 24 h,7 d and 180 d.All the patients were followed up for 180 d,and the adverse reaction of drug and the incidence of cardiovascular event were detected.Results Blood lipid levels had no significant changes in the two groups before and after treatment (P ＞ 0.05).The plasma levels of hs-CRP,MCP-1,MMP-9 were higher after treatment of 24 h than those before treatment in two groups [group A:(12.14 ± 2.71)mg/L vs.(8.76 ±2.25) mg/L,(491.75 ± 19.29) ng/L vs.(440.56 ± 13.15) ng/L,(449.6 ±11.8) μmol/L vs.(353.8 ± 16.0) μ mol/L;group B:(11.39 ± 2.38) mg/L vs.(9.30 ± 1.99) mg/L,(488.56 ± 17.61) ng/L vs.(436.06 ± 15.36) ng/L,(444.9 ± 19.1) μ mol/L vs.(349.8 ± 13.6) μmol/L],and there were significant differences (P ＜ 0.05).The plasma levels of hs-CRP,MCP-1,MMP-9 decreased significantly after treatment of 7,180 d compared with that after treatment of 24 h in two groups (P ＜ 0.05).Compared with those in group A,the plasma levels of hs-CRP,MCP-1,MMP-9 decreased even lower in group B[after 7 d:(4.51 ±1.16) mg/L vs.(5.43 ± 1.44) mg/L,(306.06 ± 18.49) ng/L vs.(384.64 ± 13.23) ng/L,(206.2 ± 16.8)μ mol/L vs.(263.4 ± 15.4)μ mol/L;after 180 d:(4.23 ± 1.08) mg/L vs.(4.68 ± 1.46) mg/L,(280.16 ± 14.54) ng/L vs.(354.64 ± 11.32) ng/L,(187.2 ± 14.2)μ mol/L vs.(225.4 ± 12.7) μ mol/L],and there were significant differences (P ＜ 0.05).After followed up for 180 d,there was no serious adverse reaction in two groups,and the total incidence of cardiovascular event in group B was lower than that in group A [7.7％(3/39) vs.25.6％ (10/39)],and there was significant difference (P ＜ 0.05).Conclusion Intensive lipid lowering therapy can reduce the level of inflammatory factors and cardiovascular event of the elder patients of ACS complicated with DM undergoing PCI and has good security.

Objective To investigate the effect of estrogen on regression of vascular calcification in rats induced by vitamin D3 plus nicotine.Methods Ninety-six female SD rats were divided randomly into control group (n=24) and calcification group (n=72).Vascular calcification of 72 rats was induced by vitamin D3 and nicotine (VDN).On the day 1,the VDN group rats were injected with vitamin D3(300 000 U/kg,i.m),and were intragastric administrated with nicotine (25 mg/kg),after 9 hours,another dosage of nicotine was given again.After 4 weeks,the VDN group rats were subdivided randomly into 4 groups:VDN group(n=16),Sham operation group (n=16),ovariotomy group (n=16),estrogen group(after ovariotomy,17β-estrogen was subcutaneously injected,50 μg· kg-1· d-1,n=16).Results After 4 weeks,the VDN group showed obvious vascular calcification,and calcium content of the vessel wall was significantly higher than that of control group (P＜0.01).Extensive calcification was witnessed on the aortic tunica media of the VDN group.After 12 and 8 weeks,the calcium content of the vessel wall in each subdivided groups was significantly lower than that at 4 weeks point(P＜0.01),and the lowest calcinm content was in estrogen group,meanwhile the reduction of previously accumulated arterial calcium precipitate in each group was different.Conclusions It is a reversible process that vascular calcification induced by vitamin D plus nicotine in rats.Estrogen can promote the regression of vascular calcification.

ObjectiveTo investigate the changes in liver function and the efficacy of either hand-assisted laparoscopic surgery (HALS) or open splenectomy (OS) in combination with pericardial devascularization in the treatment of portal hypertension. MethodsThe clinical data of 94 patients who received splenectomy combined with pericardial devascularization to treat portal hypertension due to cirrhosis from Jan 2002 to May 2008 were analyzed retrospectively. 56 patients received OS and 38patients HALS. The operating time, intraoperative blood loss, postoperative complications, liver dysfunction and mortality were analyzed according to the Child's grading. ResultsThere was no difference in the operating time between HALS and OS (P＞0. 05). The intraoperative blood loss and postoperative complications were 5.6% and 10.8%, respectively (P＜0. 05). There was no significant difference in the serum ALT between HALS and OS, but there was a significant difference in the ALB (P＜0. 05). The AST also had a significant difference on postoperative day 5 (P＜0. 05). The serum ALT and AST were elevated after HALS, but there was a significant difference only for AST (P＜0.05). The serum ALT and AST in OS were significantly higher after than before operation (P＜0. 05). The serum ALB in OS was significantly lower after operation (P＜0.05), but it was significantly lower only on postoperative days 1 and 3 (P＜0.05) in HALS. ConclusionsCompared with OS, HALS combined with pericardial devascularization caused less damage to the intestinal tract and the liver function. It is a feasible and safe operation and it had fewer postoperative complications.

AIM: To investigate the effect of lipopolysaccharide (LPS) priming on macrophage(M?). METHODS: Macrophage cell line RAW264.7 were pretreated with or without LPS for 1 h, then challenged with PMA, or LPS, muramyl dipeptide(MDP), Zymosan, formyl-methionyl-leucyl-phenylalanine(FMLP) for 1 h . O  2 production in supernatants and intracellular free calcium([Ca 2+ ]i ) were measured, and changes in [Ca 2+ ]i and LPS induced O  2 production were compared. RESULTS: LPS pretreatment significantly increased O  2 production in RAW264.7 cells challenged with the stimuli, and in a certain extent, both O  2 production and increase of resting intracellular [Ca 2+ ]i were dose- and time-dependent on LPS pretreatment.Furthermore,the peak [Ca 2+ ]i was significantly higher in LPS pretreated groups than that of LPS unpretreated groups when challenged with PMA. Pretreatment with Ca 2+ inophore A23187 mimicked the LPS priming effects on O  2 production, but pretreatment with Ca 2+ chelator BAPTA and EGTA blocked this priming effect. CONCLUSION: LPS induced M? priming effect on O  2 production is dependent on elevation of resting intracellular [Ca 2+ ]i .

Objective To study the preliminary effects of percutaneously looped thread transection on the surgical treatment of carpal tunnel syndrome (CTS). Methods A total of 72 cases (103 sides) were treated from January 2012 to Decem?ber 2014 (27 males and 45 females, aged 22-94 years, with an average of 51.3 years). Among all the cases, 21 cases (30 sides) were treated with open decompression and 51 cases (73 sides) were treated with percutaneously looped thread transection. We did the incision in the ulnaris hypothenar pattern, revealed and cut off the transverse carpal ligament to decompress the carpal tunnel in the open surgery. Percutaneously looped thread transection was under the guidance of ultrasound, threading from the deep and shallow transverse carpal ligament, respectively, forming loops to cut off and decompressed the carpal tunnel. We observed the me?dian nerve aspect ratio (the ratio of length to width of the uncinatum median nerve on transverse section) and swelling ratio (the ra?tio of area of median nerve on transverse section of pisiform and distal radius) under ultrasound before, during and 3 months after operation. Telephone follow?up was conducted in postoperative 3 months according to the Boston Carpal Tunnel Questionnaire (BCTQ) to evaluate the symptoms of carpal tunnel syndrome and wrist joint function. Results There were 11 cases lost in the fol?low?up, and 61 cases were followed up for 3 to 27 months, with an average of 11.6 months. The preoperative BCTQ scores of open decompression group and looped thread transection group were 28.5±4.6 and 29.4±5.3, respectively. There was no statistically sig?nificant difference between two groups (t=1.34, P=0.528). The postoperative 3 months BCTQ scores were 16.3±5.7 and 15.7±4.9. There was no statistically significant difference between two groups (t=1.12, P=0.674). The median nerve aspect ratios measured under ultrasound of open decompression group before and 3 months after operation were 3.8 ± 0.7 and 2.6 ± 0.4, respectively. The swelling ratios were 2.3±0.4 and 1.2±0.3. The difference of preoperative and postoperative changes was statistically significant (P<0.05). The median nerve aspect ratios measured under ultrasound of looped thread transection group before and 3 months after op?eration were 3.9±0.6 and 2.7±0.5, respectively. The swelling ratios were 2.1±0.3 and 1.4±0.4. The difference of preoperative and postoperative changes was statistically significant (P<0.05). There were no infection, poor healing, blood vessel and nerve damage after operation in both two groups. Conclusion Percutaneously looped thread transaction under ultrasound for the surgical treat?ment of CTS has less trauma and rapid recovery. It can improve the symptoms of median nerve stimulation, restore the morphology and function of the median nerve and reach the same effects as the open decompression surgery.

Vertebral artery hypoplasia is a congenital vessel variation. Its incidence is from 1. 9 to 26. 5% . In recent years, studies have shown that vertebral artery hypoplasia may be a potential risk factor for posterior circulation infarction, especialy when it coexists with other cerebrovascular risk factors. Vertebral artery hypoplasia may also cause regional hypoperfusion and complex neurovascular regulation, and it also has a certaln link with migralne.