Objective To investigate the cause and development of atrioventricular block (AVB) occurred during and after transcatheter closure of ventricular septal defect (VSD), and to explore its feasible prevention and treatment. Methods From Mar, 2005 to Dec, 2005, 157 patients who suffered from congenital VSD underwent transcatheter interventional occlusion. Transient Ⅲ degree AVB occurred in 2 patients during the transcatheter therapy and Ⅱ degree AVB in 2 patients and Ⅲ degree AVB in 3 patients were observed 4 hours to 8 days after the therapy. Two of them suffered from Adams-Stokes syndrome. All patients were treated by intravenous injection of glucocorticosteroid, diuretic and dehydrator. One of them was also treated with temporary pacing. Results AVB did not re-occurred after the transcatheter closure in 2 patients who suffered from transient Ⅲ degree AVB during the transcatheter interventional therapy. The cardiac rhythm in 3 patients who suffered from Ⅲ degree AVB after the transcatheter closure reverted to sinus rhythm in 7, 8 and 18 days after the operation respectively. However, 2 of them suffered recurrent Ⅲ degree AVB after discharge, and one of them could not be restored to sinus rhythm. Three patients who suffered from the Ⅱ degree AVB resumed to sinus rhythm in 5, 7 and 8 days after the transcatheter closure respectively, and the type Ⅰ and the type Ⅱ of Ⅱ degree AVB alternated before the rhythm completely reverted. Conclusion AVB is a frequent complication during and after transcatheter closure of VSD. AVB occurred after transcatheter occlusion should be treated actively, or it may become permanent AVB. Improving the cardiac transcatheter interventional device and technique can prevent the high degree AVB in certain degree.

With the improvement of China's population aging and health care consciousness, female pelvic floor dysfunction gets increasing attention in society. Modern TCM scholars conclude TCM doctors’ theories about etiology and pathogenesis of pelvic floor dysfunction, summarized as debility of Chong Ren meridians and inability to lift, and then they advocated invigorating qi and elevating yang, with a purpose to protect pelvic floor stability. This article conducted relevant discussion on the significance of rehabilitation of pelvic floor dysfunction based on TCM adjusting qi activity.

Objective To review the experience of aortic root internal drainage in the operation of type A aortic dissection.Methods This was a prospective and observational study.Clinical data were available from 20 cases of type A aortic dissection patients (A group) from March 2003 to March 2008,and anothcr 36 cases of type A aortic dissection patients (B group) from March 2008 to May 2013.All of patients received the operation of replacement of ascending aortic aneurysm and aortic arch replacement and descending aortic stented elephant trunk implantation in our hospital.The additional inside drainage were made between the aortic root aneurysm sac and right atrial appendage in B group.Perioperative and postoperative data including the operation time,the amount of bleeding,cardiopulmonary bypass time,the amount of red cell transfusion,number of postoperative cases re-operated for hemostasis,total drainage volume in 24 hours,amount of postoperative red blood cell transfusion,number of cases of postoperative pulmonary complications,and postoperative mortality rate were analyzed retrospectively.The data was analyzed using SPSS version10.0 software.The chi-square test was used for constituent ratios,whilest was applied to analysis of differences in above variables betweens two groups.Results There were significant differences in the amount of bleeding during surgery,cardiopulmonary bypass time,the amount of red cell transfusion,rate of postoperative re-operation,total drainage volume in 24 hours,amount of postoperative red blood cell transfusion,number of cases of postoperative pulmonary complications and postoperative mortality between the two groups (x2/t =2.658,2.381,2.265,3.056,6.862,2.896,2.316,7.215,7.668,P =0.012,0.034,0.007,0.016,0.013,0.032,0.008,0.008,respectively).Conclusions The method of aortic root internal drainage in the operation of type A aortic dissection could reduce the amount of bleeding and improve the success rate of operation.

This paper analyzed medical dispute litigation from the view of game theory.The adoption of mediation strategy for both hospital and patient was the Pareto optimal of this model.The adoption of court decision for both hospital and patient was the Nash equilibrium and its overall benefit was the Pareto suboptimal of this model.The communication of patient's lawyer can prompt the reconciliation between hospital and patient.On the one hand,it let the hospital realize the responsibilities they should bear,on the other hand let patients be willing to make concessions on the basis of the original claims,and finally made the two sides reach a reconciliation agreement,thus to make conflict between hospital and patient end in litigation and the overall benefits maximize.

Objective: To explore influence of exercise on cardiac autonomic nerve function in patients undergoing coronary artery bypass grafting (CABG) and its clinical significance. Methods: A total of 53 patients with coronary heart disease undergoing CABG were randomly divided into routine treatment group (n=25) and rehabilitation group (n=28, received exercise training based on routine treatment). Changes of autonomic nerve function before, second and eighth week after CABG were analyzed in two groups using time domain indexes of heart rate variability (HRV) by ambulatory electrocardiography, including standard deviation of normal to normal RR intervals calculated over the 24 h period (SDNN), standard deviation of normal to normal RR intervals in all 5 min segments of the entire recording (SDANN), root-mean square of differences between successive normal to normal intervals (rMSSD) and adjacent normal RR interval difference > 50ms stroke accounted for a percentage of 24h total RR interval (PNN50). Results: Compared with before CABG, there were significant decrease in SDNN, SDANN, RMSSD and PNN50 in both groups two weeks after CABG (P<0.05~0.01); eight weeks after CABG, above indexes recovered to levels before CABG in routine treatment group[SDNN （113.6±29.4）vs.（116.7±24.7）, SDANN（112.2±32.1）vs.（113.6±28.6）, rMSSD（21.9±8.2） vs.（23.2±7.1）, and PNN50 （7.5±4.2）vs.（8.2±3.7）] , P>0.05 all; Compared with before CABG, there were significant improvements in SDNN [(114.7±25.2) ms vs. (132.6±30.6) ms], SDANN [(111.6±23.5) ms vs. (129.2±30.8) ms], rMSSD [(24.2±8.7) ms vs. (29.9±7.5) ms] and PNN50 [(7.8±2.2) ms vs. (9.5±2.3) ms], and there were significant improvement than those of routine treatment group [SDNN （132.6±30.6）vs.（113.6±29.4）, SDANN（129.2±30.8）vs.（112.2±32.1）, rMSSD（29.9±7.5）vs.（21.9±8.2）and PNN50 （9.5±2.3）vs.（7.5±4.2）] eight weeks after CABG in rehabilitation group, P<0.05 all. Conclusion: All HRV indexes significantly decrease on two weeks after CABG in both groups, suggesting that CABG can damage cardiac autonomic nerve system. These indexes of rehabilitation group were more improvement than those of routine treatment group, suggesting exercise training can more significantly improve cardiac autonomic nerve function after CABG.

Objective To evaluate the advantages and disadvantages of various methods for the treatment of aortic dissection involving aortic arch. Methods The clinical data of 56 patients with aortic dissection involving aortic arch were analyzed retrospectively. All the patients were treated with throacic endovascular aortic repair (TEVAR) combined with chimney technique and hybrid operation to reconstruct partial vessels of the aortic arch according to the different morphology sites of aortic disease. Results Among 56 patients, 29 cases received TEVAR combined with chimney technique of left subclavian artery, and 27 cases received TEVAR combined with hybrid operation. Six cases had typeⅠendoleak. Among them, 2 cases improved by compliant balloon dilatation, and 4 cases were not treated. There was no death in perioperative period. The patients were followed up for 3-70 (22 ± 3) months, and all the branches of the artery were unobstructed during middle and long term follow-up. Conclusions Combined endovascular treatment is a safe and effective method for aortic dissection involving the aortic arch. In the meantime, strict preoperative evaluation and suitable operation method is also important.

Objective To summarize the experience in the treatment of Marfan syndrome of pregnancy complicated with acute type A aortic dissection.Methods Three women with Marfan syndrome of pregnancy complicated with acute type A aortic dissection were treated.The average age was 28.6 (25-31) years,and the average gestational age was 36.5 (32-38) weeks.At first caesarean operation were performed under general anesthesia.Bentall + Sun' s operation was performed under deep hypothermic circulatory.After operation,the mother and fetus were followed up.Results Three women and their fetus were safe.The average extracorporeal circulation time,aorta clamp time and circulatory arrest time were 265 (210-280) min,135 (120-160) min and 26.5 (20-29) min,respectively.After a mean follow-up of 2.0 (1.0-2.5) years,3 patients were living well.CT angiogram detected normal aortic,with no signs of distal dilation.Three fetus were normal in development and neurocognitive function.Conclusion Methods of surgical repair and fetal delivery should be chosen based on aortic pathological changes and gestational age to maximize the safety of the mother and fetus.

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AIM:To treat the chemotherapy-induced premature ovarian failure ( POF) rats with the methods of tonifying kidney yin and yang by observing the indicator changes in apoptosis of ovarian granulosa cells and related cyto -kines before and after medication .METHODS:SD rats ( n=36) were chronically given intraperitoneal injection of cyclo-phosphamide ( CTX) for 15 d in order to establish the animal model of POF .The rats were randomly divided into control group, CTX group, CTX+kidney yin group and CTX +kidney yang group.The levels of tumor necrosis factor alpha (TNF-α) and interferon gamma ( IFN-γ) in the peripheral blood were detected by ELISA .The apoptosis of ovarian granulosa cells was observed by TUNEL method .The levels of apoptosis related proteins were determined by Western blot .RE-SULTS:After modeling , the levels of TNF-αand IFN-γin the peripheral blood were significantly increased .The protein expression of Bax was up-regulated and Bcl-2 was down-regulated .The apoptosis of ovarian granulosa cells was significantly induced with a deep staining .After treatment with tonifying kidney yin and yang , the levels of TNF-αand IFN-γin the pe-ripheral blood were decreased , the protein expression of Bax was down-regulated and Bcl-2 was up-regulated, and the apop-tosis of ovarian granulosa cells was reduced .CONCLUSION:The reserve function of the ovarian can be recovered by pre-scriptions of tonifying the kidney yin and yang via regulating the expression of TNF -α, IFN-γ, Bax and Bcl-2, and inhibi-ting the apoptosis of ovarian granulosa cells .

Objective To explore the mechanisms of synergic action of commonly-used herb pair of Radix Sophorae Flavescentis (Kushen, KS) and Fructus Cnidii (Shechuangzi, SCZ) for the treatment of pruritus. Methods We predicted and analyzed the potential targets of KS and SCZ based on network pharmacology method, and then established Chinese herbs-compound skeletons-targets networks to reveal anti-pruritus targets, predicting targets, and the interaction of KS and SCZ, as well as the components of the herb pair. The RAW264.7 inflammatory cell model was established to observe the synergistic anti-inflammatory activity of KS and SCZ. Results KS and SCZ had possible synergic action on the pruritus-related targets such as histamine receptors, cannabinoid receptors and proteinase-activated receptor 2. Additionally, KS and SCZ probably had synergic regulation of inflammation-related pathway (Toll -like receptor signaling pathway , chemokine signaling and Fc epsilon RI signaling pathway) and nerve-related pathway(neurotrophin signaling pathway) during the treatment of pruritus. Flavones from KS and coumarin of SCZ had various synergistic anti-inflammatory activities(P<0.05), indicating that they played an important role in inhibiting pruritus induced by inflammation. Conclusion The method may reveal the molecular mechanism of KS and SCZ in inhibiting pruritus, which is important for the modernization of Chinese medicine and new drug development.