Objective The purpose of this study was to assess the incidence,treatment and prognosis of silent pulmonary embolism (PE) after off-pump coronary artery bypass graft (CABG).Methods From December 2009 to September 2012,582 consecutive patients underwent off-pump CABG by a same surgeon.Their age ranged from 16 to 86 years with a mean age of (61.4 ± 9.3) years.Left internal mammary artery and saphenous vein were harvested routinely.A dose of 20 mg unfractionated heparin was given intravenously every 6 hours on the operative day after postoperative pleural fluid less than 50 ml per hour.All patients received aspirin 100 mg daily starting on postoperative day 1.The 64-slice coronary MDCT was performed to assess the graft patency on postoperative day 5 ～ 7.Results There were no in-hospital death.PE,which involved the lobar or more proximal arteries,was detected on the CT images of 10 patients (1.7％).In these 10 patients,there were no significant dyspnea or hypoxemia postoperatively ; echocardiography and ECG showed no specific signs of PE ; all bypass grafts were patent in CT images except a LIMA to LAD graft with LAD endarterectomy.PE involved both lungs in 6 patients,and only the right lung in 4 patients.All patients received anticoagulation with warfarin for 3 to 6 months except one.All patients were with good quality of life during 6 to 18 months of follow-up.Three to six months after discharge,8 patients received repeated MDCT,which showed diminish of PE.Conclusion Acute PE after off-pump CABG was an uncommon complication and was difficult to diagnose.MDCT played an important role in examining the patency of graft vessels and helped detect silent PE in CABG patients.The prognosis of acute PE after off-pump CABG was acceptable.PE diminished after 3 months of anticoagulation with warfarin.

As one branch of epigenetics, the sirtuins family ( ClassⅢ histone deacetylase) receive much attention in recent years. SIRT1 as the most famous of the sirtuins family members has been verified involved in a variety of age-related diseases. While the SIRT1 formation is paid more and more attention in age-related cataract. Now, we briefly overviewed the research progress on the role of SIRT1 in age-related cataract.

Clinical features and thyroid-stimulating antibody(TSAb)in 32 newly diagnosed patients with Graves' ophthalmopathy(GO)were compared with those in 27 Graves' disease(GD)patients without GO(as control group).All of the patients with GO received intravenous glucocorticoids.The level of serum TSAb in patients with GO was significantly higher than that in patients without GO.TSAb was also associated with the prognosis.It suggests that TSAb seems to be the most active component among the TSH receptor antibodies related to ophthalmopathy and may act as a predictive parameter.

Objective To compare the efficacy and adverse effects of 5 days' and 7 days' course of combination chemotherapy regimen HA in the treatment of chronic phase of chronic myelogenous leukemia (CML-CP). Methods 18 cases of CML-CP had received 5 days' course of combination chemotherapy regimen HA including homoharringtonine 4 mg/d and cytarabine 200 mg/d for 5 days. At the same time,another 18 patients diagnosed as CML-CP who were given 7 days' course of HA regimen including homoharringtonine 4 mg/d and cytarabine 200 mg/d for 7 days were compared on the efficacy including peripheral white blood cells, spleen size and cytogenetic responses and adverse effects. Results The complete remission(CR) rate was 50.0 % and 61.1 % in 5 days' and 7 days' treated groups, respectively (P >0.05). The incidence of severe bone marrow suppression in 7 days' group(16.7 %) was higher than that in 5 days' group(0)(P <0.05). Conclusion The 5 days' course of combination chemotherapy HA regimen is same as 7 days' course of HA regimen about their curative effects in CML-CP. But the incidence of severe bone marrow suppression in 7 days' group(16.7 %) was higher than that in 5 days' group (0).

Objective To establish a rabbit model of radiation-induced skeletal muscle injury in order to study the ultrastructural pathological changes and underlying mechanism.Methods 28 New Zealand rabbits were randomly divided into 2 groups with 16 rabbits in experimental group and 12 rabbits in control group.The experimental rabbits were irradiated on hip with a single dose of 80 Gy of 9 MeV electrons from a linear accelerator.1 month and 6 months after irradiation the pathological changes were respectively observed under light microscope and electron microscope.Results One month after irradiation,the morphologic changes including degeneration,necrosis of muscle cells,and hemorrhage between the muscle cells were observed under light microscope and the swelling of myofibrillae,blurring of light and shade band,vacuolar degeneration of mitochondria and amorphous areas of necrosis were observed under electron microscope.Six months after irradiation,the morphologic changes of nucleolus chips,fibrous connective tissue,thickening of vascular wall and vascular congestion between the muscle cells and the amorphous areas of necrosis in the experimental group were much more serious than those of 1 month after irradiation.In addition,the myofilaments were lost in degeneration areas and the sarcomere became shorten.Observation with electron microscope showed that the mitochondrial size and its morphological changes were varied and the amounts of collagen between myofibrillaes were increased 6 months after irradiation.Conclusions A rabbit model of high-dose irradiated skeleton muscle injury was successfully established with a single dose of 80 Gy of 9 MeV electrons from a linear accelerator.The degeneration and necrosis of muscle cells may be promoted by mitochondrial and vascular injury,degeneration of vessel and nerve fiber.

Objective:By applying moxibustion to the eight confluent points in different periods of time,to observe the changes in thermal pain threshold latency of acupoints based on Fei Teng Ba Fa.Methods:A total of 468 healthy college student volunteers received moxibustion at the eight confluent points in three different periods of time,i.e.Chen (7:00-9:00),Wu (11:00-13:00) and Xu (19:00-21:00).The thermal pain threshold latency was adopted to measure the changes in pain threshold of the eight confluent points under different conditions (different periods of time,different genders,different acupoints and different states of the acupoints) based on Fei Teng Ba Fa.Results:Finally,thirty subjects dropped out and 438 subjects were included.The comparison of thermal pain threshold latencies of the eight confluent points in the same opening or closing state based on Fei Teng Ba Fa:latencies of the closing points and adjunct points were significantly different in different periods of time (P＜0.05);the latencies of the males were significantly longer than those of the females (P＜0.05);there was no significant difference in the latency between the left and right sides (P＞0.05);in the female group,there was a significant difference in the latency between the lower-limb points and the upper-limb points (P＜0.05).The comparison of thermal point threshold latencies of the eight confluent points in different opening or closing state:in the period of Wu (11:00-13:00),the latencies of the opening points were significantly longer than those of the closing points and adjunct points (P＜0.05);for men,their opening and closing points had significantly longer thermal pain threshold latencies than their adjunct points (P＜0.05);despite the gender,the latencies of the upper limb opening and closing points were significantly longer than the latency of the adjunct points (P＜0.05);in the female group,the latencies of the lower-limb opening points were significantly shorter than those of the lower-limb closing and adjunct points (P＜0.05).Conclusion:Based on Fei Teng Ba Fa,the pain thresholds of the eight confluent points vary in different periods of time,gender,acupoint location and opening/closing state,which can be taken as the evidence of making time-based acupuncture-moxibustion prescriptions.

The improvement of diagnostics teaching system,including the establishment of curriculum system and evaluation system,is the base of promoting clinical- medicine teaching.Our study showed that the theoretical knowledge and clinical skill of medical students could be improved by constructing clinical diagnostics curriculum system and improving organization management and assessment system,which could pave the way for the transition from medical students to clinicians.

Objective To investigate the association between Bsml polymorphism in vitamin D receptor (VDR) gene and diabetic nephropathy in Chinese Han population. Methods PCR-restriction fragment length polymorphism (PCR-RFLP) was used to test the genotype and allele frequency of Bsml in 304 patients with type 2 diabetes mellitus (DM group) and 100 healthy individuals (NC group).The DM group was further divided into non-diabetic nephropathy group (DN0 group,122 cases),minimal albuminuria group (DN1 group,87 cases),and mass albuminuria group (DN2 group,95 cases).Eighty-three DM patients without nephropathy for over 5 years were L-NDN subgroup,and 64 DM patients with nephropathy occurring within the first year were EDN subgroup. Results Genotype and allele frequency of BsmI polymorphism were significantly different between DM and NC group (x2=7.088,P=0.008;x2=5.865,P=0.015).BB+Bb genotype and B allele frequency were significantly higher in DN2 group than those in NC group (x2=14.287,P=0.000;x2=12.621,P=0.000) and DN0 group (x2=8.063,P=0.005;x2=8.173,P=0.004).BB+Bb genotype and B allele frequency were significantly higher in EDN group than those in L-NDN group (x2=7.228,P=0.007; x2=5.853,P=0.016).DN patients with allele B (BB and Bb genotypes)presented higher urinary albumin excretion rates compared with patients without allele B (bb genotype,P＜0.01).The genotype of BsmI was correlated with DN,and allele B was risk factor of DN occurrence and early onset (OR=2.004; OR=2.394). Conclusion VDR gene BsmI polymorphism is associated with DN,and the patients carrying allele B are more involved in mass albuminuria and eady onset of nephropathy.

Objective To investigate the effect on the miemvnscular density(MVD)and the expression of vascular endothelial growth factor(VEGF)in VX2 tumor after transcatheter arterial chemoembolization(TACE)combined with endostatin.Methods The VX2 tumor model wag established.The rabbits bearing tunlor were randomly divided into three groups as the control group.TACE group and TACE combined with endostatin group.with 10 rabbits in each group.In the control group,normal saline was administered via the hepatic artery.In the TACE group,lipiodol(0.2 ml/kg)and ADM(2.g/kg)were administered.Lipiodol(0.2 ml/kg),ADM(2 mg/kg)and endostatin(2 mg/kg)were administered for each rabbit in the TACE combined with endostatin group.Seven days after operation,the rabbits were sacrificed and the tumors were removed.Immunohistochemistry wag performed to demonstrate the expression of VEGF and the MVD wag caleulated.The ANOVA wag used for statistics.Results The average absorbance values of VEGF were 0.130±0.038.0.200±0.049 and 0.120±0.047 respectively for the 3 groups.There was signiflcant difference among the three groups(F=9.42,P＜0.01).rnle expression of VEGF in the TACE group was the hiShest among the 3 groups.Compared with the otIler two groups,there had signifieant differences(q=4.93,5.63,P＜0.01).The average absorbance value of the TACE combined with endostatin group was lower than that of control group,but there was no significant difference between them(q=0.70,P＞0.05).The values of MVD were(80±17),(84±16)and(57±13)/HPF for the 3 groups respectivelv.There wag significant difference among them(F=8.70,P＜0.01).111e value of MVD in the TACE combined with endestatin group was the lowest, and there were significant differences when compared with the control group (q=4.63, P＜0.01) and the TACE group (q =5.48, P＜0.01).There was no significant difference between the control group and the TACE group (q = 0.85, P ＞ 0.05) in MVD.Conclusion Compared with chemoembolization only, ehemoembolization combined with endostatin can significantly depress the expression of VEGF and decrease the angiogenesis of the tumor.The combined method has a beneficial effect on prognosis of hepatic tumor.

Objective To analyze the genotypic characteristics of hepatitis B virus (HBV)C/D recombinant of two types of newly discovered HBV genotypea found in Western China.Methods The whole genomes of 17 HBV strains isolated from Western China were amplified by polymerase chain reaction (PCR). Bioinformatic softwares were used for the analysis of full genome structure,genetic distances and recombination points.Results The heterogenicity of the HBV C/D recombinant was more than 8% compared with genotype A,B,D,E or F,but 3.8% 0A-8.O% compared with genotype C Based on phylogenetie analysis, a11 C/D recombinant strains clustered within genotype C.but were rouped into two other clusters within the genotype C independently from C1-C5 subgenotypes,which were two kinds of new HBV/C genotypea.Condusion The HBV C/D recombinant could he considered as tWO kinds of new subgenotypea of HBV genotype C which are different from subgenotype C1-C5 based on the genetic distances analysis.