Objective To evaluate the effects of unilateral extralevator abdominal-perineal excision (ELAPE) surgery and the ELAPE surgery on the pelvic floor detected by finite element analysis. Methods Three kinds of finite element mod?el were developed:the intact model, ELAPE model and the unilateral ELAPE model. The maximal stress and stress distribu?tions of each model under the same pressure were analyzed and compared. Results In the unilateral ELAPE model, non-le?vator ani tissue’s maximal stress on the levator ani reserved side was lower than that in ELAPE model, and was similar to that in the intact model. Its maximal stress on the excised side was lower than that in ELAPE model, and which was higher than that of intact model. Its maximal stress on the reserved side was lower than that of on the excised side. Conclusion Compared to the ELAPE surgery, the unilateral ELAPE surgery is able to reduce the stress of non-levator ani tissue on both sides, especially on the levator ani reserved side.

Objective To explore the effects of different types of passive and active movements of foot and ankle on the venous return in the lower limb in order to provide evidence for prevention of venous stasis and deep- vein thrombosis(DVT)after joint replacement. Methods Peak and average velocities of the femoral vein were detected and measured by using color ultrasound Doppler on 30 limbs in 15 healthy volunteers under the circumstance of resting and different types of passive and active movements of foot and ankle. Results During the passive movements of the flexion and extension, inversion and eversion, and the circumduction of foot and ankle, the flexion and extension as well as the inversion and eversion only slightly increased the velocities of venous blood flow. The circumduction produced a higher increase in venous blood flow than the former two movements, increasing the peak velocity by 31.3％ and average velocity by 33.9％ . In the same 3 types of the active movements of foot and ankle, the active flexion and extension, inversion and eversion resulted in increases in peak velocity of 41.3％ and 32.9％ and in average velocity of 40.1％ and 32.4％ , respectively. The active circumduction of foot and ankle produced the strongest influence on the promotion of venous blood flow with the peak velocity increased by 69.3％ and average velocity by 69.1％ . Conclusion The active circumduction, flexion and extension, inversion and eversion, and the passive circumduction of foot and ankle can be utilized to prevent DVT after joint replacement. The active circumduction of foot and ankle is the optimal exercise to prevent DVT.

Objective To investigate the selection of the types of anastomosis of bilioenterostomy and evaluate the therapeutic effects.Methods From 1990 to 2000,536 patients with obstructive jaundice underwent bilioenterostomy in our hospital.The patients included 279 cases(52%) of hilar strictures with hepatolithiasis,108 cases(20%) of end stage periampullary tumors,96 cases(17%) of proximal cholangiocarcinoma and 53 cases(12%) of congenital choledochus cyst.The types of anastomosis included extra or hilar hepatic bilioenterostomy in 302 cases(56%),intra hepatic duct anastomosis with different type of hepatectomy in 222 cases(42%),of which 44 cases(8%) were anastomosed by roud ligament approch,27 cases(5%) through gallbladder fossa.Results The short term and 1～9 years long term follow up indicated that the jaundice of different patients can be completed relieved by suitable type of bilioenterostomy.Conclusions The good therapeutic effects of bilioenterostomy come from the correct selection of the anastomosis methods.

Heart Failure ; Humans ; MicroRNAs

Objective To evaluate the prognostic values of leukocyte count,hemoglobin,biochemical parameters,erythrocyte sedimentation rate and immunoglobulin on mortality in patients aged 80 years and over.Methods Totally 342 patients(aged 85.6±4.0 years)were followed up for (82.0±36.9) months,and the cause and time of death were recorded.Results During the period of follow up,198 patients suffered from death.Compared with the survival group (132 cases),the death group had older age [ (86.5±4.4)years vs.(84.5±3.2)years,t=-4.86,P＜0.01 ],higher white blood cell [ (6.2± 1.7) ＞ 109/L vs.(5.5±1.3) × 109/L,t=-3.93,P＜0.01 ],lower hemoglobin [(134.4±14.4)g/L vs.(140.0± 12.6)g/L,t= 3.65,P＜0.01 ],slightly faster erythrocyte sedimentation rate [ 11 mm/h(15 mm/h) vs.9 mm/h (10 mm/h),U=- 3.31,P＜0.01 ],lower immunoglobulin M [ (0.9±0.5)mg/L vs.(1.1±0.8)mg/L,t =2.55,P＜0.05 ],slightly higher urea nitrogen [ (7.5±2.6) mmol/L vs.(6.8±1.6) mmol/L,t=2.81,P＜0.01]and creatinine [(113.0±32.5) μmol/L vs.(100.5±15.8) μmol/L,t=-4.65,P＜0.01 ].Cox multivariate analysis revealed that older age (RR=1.083,95％CI:1.040 1.127,P＜0.01),white blood cell count (RR=1.134,95％CI:1.021-1.260,P＜0.05),creatinine (RR=1.011,95％CI=1.0021.020,P＜0.05),hemoglobin(RR=0.835,95％CI:0.714-0.975,P＜0.05)andimmunoglobulin M(RR=0.710,95％CI:0.521-0.966,P＜0.03),aorticaneurysm(RR=2.144,95％CI:1.163-3.951,P ＜ 0.05 ) were the independent risk factors for death.Conclusions Aging,increased WBC count,decreased hemoglobin and immunoglobulin M,elevated creatinine and aortic aneurysm are the independent risk factors for death,which are powerful parameters for the prognostic evaluation in the elderly aged 80 years and over.

AIM: To observe the effect of (IFN-?1b) on morphology and the expression of connective tissue growth factor (CTGF) in hepatic stellate cells (HSC). METHODS: HSC were cultured in vitro, and were treated with (IFN-?1b) and TGF-?_1. The changes of HSC on morphology were observed, and the expression of CTGF in HSC was assessed using reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Phenomenon of apoptosis were observed in HSC treated with IFN-?1b. The expression of CTGF in HSC was decreased after treatment with (IFN-?1b) in control and TGF-?1-triggered groups. CONCLUSION: (IFN-?1b) is able to induce the apoptosis and suppress the expression of CTGF in HSC.

BACKGROUND:Nowadays,liver grafts for transplantation are clinically sourced from non-heart-beating donors.Moreover,there is still no uniform determination of safe time limit points for non-heart-beating donor liver in warm ischemia and cold preservation.OBJECTIVE:To evaluate the application safety and curative effects of warm ischemia liver graft affected by varied cold ischemia time (CIT) in liver transplantation.DESIGN,TIME AND SETTING:A randomized controlled observation was performed in the Organ Transplantation Center,First Affiliated Hospital of Sun Yat-sen University between January 2006 and December 2007.PARTICIPANTS:154 cases who underwent non-heart-beating liver transplantation were included in this study.All liver graftsinvolved had a warm ischemia time(WIT) less than 10 minutes.METHODS:All cases were assigned into 3 groups according to CIT:group Ⅰ (CIT＜8 hours,n=58),group Ⅱ (CIT 8-12hours,n=62),and group Ⅲ (CIT 13-16 hours,n=34).The liver grafts were randomly allocated for the patients.Following liver transplantation,the same immunosuppression protocol was employed for each group.MAIN OUTCOME MEASURES:Following surgery,peak level of alanine aminotransferase (ALT),primary graft dysfunction (PGD) after liver transplantation,acute rejection response,biliary complications,vessel complications,perioperative infections,graft and recipient survival rate were compared among 3 groups.RESULTS:Follow-up time was 8-32 months.No PGD was detected in all 154 cases.Group Ⅱ showed postoperative ALT peak levels significantly higher than group Ⅰ (P＜ 0.05).There was no significant difference between groups Ⅰ and Ⅱin terms of acute cellular rejection,perioperative infection,biliary complication,vessel complication,graft survival rate,and recipient survival rate (P＞0.05).Compared with group Ⅰ,the group Ⅲ exhibited significantly increased postoperative ALT peak level,biliary complications,and perioperative infections,and significantly decreased graft and recipient survival rate (P＜0.05).CONCLUSION:Non-heat-beating-liver grafts with less than 10 minutes of warm ischemia can tolerance 12 hours of cold ischemia.More than 12 hours,postoperative liver transplantation complications ascend and,contradictorily,graft and recipient survival rate descend.

Objective To observe the changes of serum soluble CD40 ligand (sCD40L) and fibrinogen in acute myocardial infarction (AMI) patients and to investigate the clinical predictive value of increased serum sCD40L and fibrinogen. Methods Serum sCD40L level of 60 AMI patients was determined by enzyme-linked im-munosorbent assay (ELISA). Plasma level of fibrinogen was measured. The patients were followed up for 2 years af-ter discharge from the hospital and were observed for cardiovascular event. Results AMI patients had higher sCD40L and fibrinogen levels than those of controls [(15.36±7.32) μg/L vs. (5.79±2.78) μg/L, (4.60±1.37)g/L vs. (3.03±0.82) g/L,P<0.001] ,which were significantly higher in the patients experiencing cardio-vascular event than those without cardiovascular event [(18.14±6.34) μg/L vs. (14.38±6.67) μg/L and (4.97±1.33)g/L vs. (4.20±1.24} g/L] (P<0.05). The patients with sCD40L≥14.5 μg/L or fibrinogen≥ 4.4 g/L experienced increased risk of adverse cardiovascular events (P<0.05). In AMI patients, sCD40L level was significantly higher in patients with diabetes than in nondiabetics [(18.38±6.71) μg/L vs. (14.46±6.48) μg/L, P<0.05)]. Fibrinogen level was related to sCD40L (r=0.27, P<0.05) and LVEF(r=-0.319, P<0.05). Conclusion Increased sCD40L and fibrinogen levels,which maybe related to the pathogenesis of AMI,can be found in AMI patients and can indicate an independent increased risk of major adverse cardiovascular events. Diabetes is independently associated with elevated sCD40L level in AMI patients.

Objective To evaluate the efficacy of liver grafts with warm ischemia and with different cold preservation time in liver transplantation.Methods The clinical data of 154 patients who received liver transplantation at the First Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2007 were retrospectively analyzed.The warm ischemia time of the liver grafts obtained from the non-heart-beating donors was within 10 minutes.According to cold perservation time of the liver grafts,patients were divided into 3 groups:the cold preservation time of the liver grafts was within 8 hours,8-12 hours and above 12 hours in group I(n=58),group Ⅱ(n=62)and group Ⅲ(n=34),respectively.The peak level of alanine aminotransferase(ALT),primary graft dysfunction(PGD)after liver transplantation,acute rejection response,biliary complications,vessel complications,perioperative infections and the survival of liver grafts and recipients among the 3 groups were analyzed via chi-square test,t test and variance analysis.Results No PGD was detected in the 3 groups after liver transplantation.All patients were followed up for 8-32 months.The peak level of ALT,incidence of infection and biliary complication,survival of liver grafts and recipients were(482±357)U/L,12%(7/58),12%(7/58),86%(50/58)and 88%(51/58)in group Ⅰ,and were(1274±608)U/L,29%(10/34),26%(9/34),68%(23/34)and 71%(24/34)in group Ⅲ,with significant difference between the 2 groups(t=5.23,X~2=4.28,6.77,4.51,4.28,P<0.05).The peak level of ALT in group Ⅱ was(953±424)U/L,which was significant higher than(482±357)U/L in group Ⅰ(t=4.76,P＜0.05).Conclusions Liver grafts with a warm ischemia time shorter than 10 minutes could tolerate the injury caused by cold preservation with the maximum time of 12 hours.The incidences of biliary complications and postoperative infections are significantly increased and the survivals of liver grafts and recipients are decreased when the cold preservation time exceeds 12 hours.

Objective To evaluate the prognostic value of ~(99m)Tc-MIBI myocardial perfusion single-photon emission computed tomography (MPS) with adenosine triphosphate in patients aged 80 years or older. Methods A total of 265 patients [ mean age (84. 2 ±3.6) years old ] who underwent adenosine triphosphate and rest ~(99m)Tc-MIBI myocardial SPECT imaging were followed-up for (36. 7 ± 22. 8 ) months. Results During the period of follow-up, 57 patients (20. 4% ) suffered from cardiac events, including 20 major events: 5 cardiac death and 15 acule non-fatal myocardial infarction, 14 unstable angina pectoris,7 heart failure and 16 cases undergoing PCI. The cardiac event rate in patients with fixed or mixed perfusion defects (n = 54) was 50%, which was significantly higher lhan that in patients with reversible perfusion defects(n=67, 31. 3% ,P<0. 05) and normal perfusion imaging( n = 144, 6. 2% ,P <0. 01 ) . The major cardiac event rate in patients with fixed or mixed perfusion defects was 27. 8% , which was significantly higher than that in those with reversible perfusion defects ( 6. 0% , P < 0. 05) and normal perfusion imaging (0.7%, P < 0. 01 ) . Cox multivariate analysis revealed that an abnormal MPS was the most important independent predictor of major or total cardiac events. Conclusions ~(99m) Tc-MIBI MPS with ATP is demonstrated to be a powerful tool for the prognostic evaluation in octogenarian population. Octogenarians with a normal MPS have a low risk of major or total cardiac events, but when an abnormal MPS is present, the risk is significantly higher, being highest in patients with fixed or mixed perfusion defects.