With improvement in stent designs, the practice of direct stenting (DS) without balloon predilation has become more widespread. DS may allow partial retention of endothelium within treated arteries, and associate with decreased utilization of contrast agent, number of catheter, exposure of X-ray,and expense. This paper evaluate the experiment base, principle, indication, contraindication, skills, complications as well as the result of acute and chronic follow up of DS.

ObjectiveTo explore the cause of early death (death within 3-12 months after hemodialysis) and the related influencing factors patients undergoing maintenance hemodialysis (MHD) as to provide a scientific basis for the prevention of early death.Methods A retrospective matched controlled study was conducted. Fifty-one patients who underwent MHD from January 2004 to April 2014 and died within 3-12 months after hemodialysis in hemodialysis center of the 174th Chinese People's Liberation Army Hospital were included in the case group by retrospective analysis method. According to 1∶2 matched controls, 102 patients underwent hemodialysis in the same period (±2 months) and survived over 12 months were selected as control group. All patients received regular hemodialysis (dialysis 2-3 times per week), with conventional limitation of water and sodium intake, routine treatments such as control of blood pressure, treatment of anemia and disorders of calcium and phosphorus contents. Causes of short-term death were analyzed. Clinical and biochemical parameters of two groups were collected when dialysis was started, and the single factor and multiple factors logistic regression was used to analyze the related risk factors when dialysis was started. Receiver operating characteristic curve (ROC) was plotted to evaluate the value of above parameters in predicting the early death in patents with MHD.Results The main causes of early death of 51 patients with MHD were mainly cardiovascular and cerebrovascular diseases (27 cases, 52.9%), and infections (15 cases, 29.4%). It was shown by single factor analysis that the age [odds ratio (OR) = 6.625, 95% confidence interval (95%CI) = 3.232-13.580,P = 0.000], diabetes (OR = 3.875, 95%CI = 0.654 - 10.622,P = 0.031), specialist intervention time before dialysis (OR = 0.349, 95%CI =0.287 - 0.572,P = 0.004), the emergence of cardiovascular and cerebrovascular events before dialysis (OR = 9.667, 95%CI = 4.632 - 20.174,P = 0.000), the first dialysis for emergency dialysis (OR = 3.875, 95%CI = 1.713 - 8.765, P = 0.005), blood albumin level (OR = 0.294, 95%CI = 0.068 - 0.550,P = 0.008), leukocyte count (OR = 6.286, 95%CI = 1.648 - 23.982,P = 0.026), neutrophil count (OR = 2.833, 95%CI = 1.630 - 4.923,P = 0.001) might be the factors correlating with early death. Eight independent factors were statistically significant, and their effect on the MHD patients was analyzed by logistic regression analysis inα = 0.05 level. The results showed that patients with old age (OR = 1.054, 95%CI = 1.019-1.090,P = 0.002), and the emergence of cardio-cerebrovascular events (OR = 7.469, 95%CI = 2.474 - 22.545,P = 0.000)were early death risk factors of MHD patients, and early specialist intervention before dialysis was a protective factor (OR = 0.286, 95%CI = 0.113-0.722,P = 0.008). ROC curve showed that age had moderate diagnostic value for early death of MHD [area under ROC curve (AUC) = 0.756], the cut-off value was 59.0 years old, the sensitivity was 66.7%, and the specificity was 77.5%. The diagnostic value of early specialist intervention before dialysis was relatively low (AUC = 0.367), the cut-off value was 0.875 years, the sensitivity was 39.2%, and the specificity was 33.3%.Conclusion Old age, the emergency of cardiovascular and cerebrovascular events before dialysis is associated with early death, and specialist intervention ahead of dialysis can reduce the risk of early death.

Objectives:To investigate the effect of glutamine on the shape of residual intestine and colon in rats with short bowel syndrome.　Methods:23 male Sprague-Dawley rats,underwent a 80% small bowel resection,were randomly divided into three groups:food group(n=8) rats,fed rat chow and water libitum after operation;TPN group(n=8),infused with Gln-supplied TPN;and normal control group.On seventh day after operation,rats were weighted and remaining jejunum、remaining ileum and colon were harvested for histological observation(light microscopy and electron microscopy).　Results:There was significant difference in rat average weight between food group and Gln group after operation.Jejunal mucosal villus height(VH) and mucosal thickness(MT) and ileal mucosal VH in food group were significantly increased than those in control group.Jejunal mucosal VH and MT in control group were significantly higher than in TPN group.Ileal mucosal crypt depth(CD) and MT in control group were also significantly higher than in TPN group.Jejunal and ileal mucosal VH、CD and MT in Gln group were significantly higher than in TPN group.Colonic MT in food group was significantly higher than in control group.Colonic MT in Gln group was significantly bigger than in TPN group.　Conclusions:After 80% intestinal resection,the remaining intestine can develop the adaptation,but the adaptation is incomplete.TPN therapy can maintain body weight,but only TPN can not result in the adaption.Gln-supplied TPN can stop the remaining itestinal mucosal atrophy,and promote the remaining intestinal adaptation and colonic mucosal hypertrophy.

BACKGROUND:Finite element analysis has been widely used for the research of bone and joint biomechanics, but the reports about finite element analysis of distal tibial articular surface defect are rare at home and abroad. OBJECTIVE:To establish ankle three-dimensional finite element model, produce distal tibial articular surface defects with different areas, and to simulate the distal tibial articular surface deformation and displacement under the different phases, thus predict the maximum al owable degree of distal tibial articular surface defect and explore the mechanics pathogenesis of ankle traumatic arthritis. METHODS:Continuous tomographic images were obtained by multi-slice spiral CT scan of a normal adult male ankle, and then the images were imported into the Mimics medicine modeling software to generate a entity model;the large general-purpose finite element analysis software ANSYS 13.0 was used for meshing, material property assignment and generating a finite element model. Restricted boundary conditions and simulated ankle distal end axial force, and then the stress distribution and displacement results of distal tibial articular surface in different phases were obtained. RESULTS AND CONCLUSION:The total number of units of the established finite element model of ankle joint was 157 990, and the total number of nodes was 193 801. On three phases, with the increase of the distal tibial defect area, the contact area was gradual y decreased, especial y in plantar flexion with the defect diameter of 13 mm, the change of the area was most obvious;The contact area of the neutral position was largest;with the increase of the distal tibial defect area in the neutral position and dorsiflexion, the peak stress was increased gradual y, and significantly increased after the diameter changed into 11-13 mm;in the neutral position and 10° of dorsiflexion, the peak stress mainly concentrated in the posteromedial and posterolateral quadrant;in 10° of plantar flexion, the change was complex, and when the diameter was 11-13 mm, the peak stress was increased gradual y with the increasing of defect area, when the diameter increased to 13 mm, the peak stress reached maximum. The maximum diameter of distal tibial articular surface defect was considered to be 11-13 mm. The joint function wil be affected when the diameter of distal tibial articular cartilage and bone bed defects was more than 11-13 mm.

Objective To observe the influence of emergency PCI in different time windows to cardiac scar and cardiac function after myocardial infarction. Methods One hundred and twenty-seven patients with acute myocardial infarction, who were treated in different time windows by emergency PCI, were enrolled into this study. The cases were divided into two groups according to the time when they took PCI after onset;group 3 hPCI included 66 patients had PCI at 3 h after onset and group 6 hPCI included 61 patients had PCI at 6 h. At 4th, 8th and 12th weeks, the fragmented QRS (fQRS) were observed by twelve synchronization cardiogram; ventricle wall movement strain rate were determined by cardiac speckle tracking imaging;left ventricular ejection fraction (LVEF)were measured by cardiac ultrasound to evaluate cardiac events and cardiac function after myocardial infarction. Results At 4th,8th and 12th weeks,the fQRS positive leads were significantly more in 6 hPCI group than 3 hPCI group ( P ＜ 0. 05 respectively ) . The ventricle wall movements strain rate and LVEF improved significantly in 3 hPCI group compared with 6 hPCI group (P ＜ 0. 05 ). Conclusions The earlier emergency PCI treatment was applied and the earlier the"criminal"blood vessels were opened ,the more ischemic myocardial cells were restored. Combination use of fQRS、 STI and LVEF examination could improve the diagnosis of cardiac scar formation and direct protective therapy.

Objectives:To investigate the effects of intravenous LCT or MCT/LCT fat emulsions on the lipid mediators and pancreatic histological changes in ANP rats. Methods:Forty three male SD rats were randomized to groups as follow.Group A～C were without ANP, group A:normal controls, group B:normal rats having received lipid based TPN and group C:operation control(OC) group having received the glucose fluid.Group D～F were with ANP,glucose group,Intralipid group and Lipofundin group.The amylase and prostaglandins in serum were determined in group A.Pancreatic histological examinations were also performed.In group B～F,Amylases or prostaglandins in serum were determined at 4,48 and 72 h, and pancreatic histological examination and pathological scoring were also completed. Results:Intralipid had no effects on serum prostaglandins when it was infused to normal rats.In groups of ANP,intravenous fat emulsion increased the 6 keto PGF 1? ,and PGE 2 concentration in serum at 4 h.Pancreatic hemorrhagic and fat necrosis were significantly reduced in Lipofundin group. Conclusions:Intravenous fat emulsion does not worsen the damages to pancreas in ANP.MCT/LCT fat emulsion is more suitable for patients with ANP.

This article introduces a novel scavenger for waste anesthetic gas which makes use of negative pressure in operating room. This setting can scavenge the exhaust gas absolutely without affection the normal work of anaesthesia.
Anesthetics ; Gas Scavengers ; Operating Rooms

Objective To investigate the outcome of high-risk acute non-lymphocytic leukemia treated with sequential low-dose cytarabine and harringtonine(LD-HA) and standard induction. Methods 50 high-risk ANLL. patients (LD-HA group) who were regarded as unfit for intensive chemotherapy were chosen to receive LD-HA. Reinductive treatments with standard regimens would be given for those who did not achieve complete remission. 23 patients DA/HA group given two cycles of standard inductive regimens were taken as the control. Results In LD-HA group 80.0 %. (40/50) reached CR, 2 patients died shortly after inductive therapy. The median leukemia-free survival(LFS) was 19.6 months, and the median overall survival (OS) was 12.2 months. Overall survival was 57.0 % at 1 year, 24.1% at 3 years, and 18.8 % at 5 years. While the CR rate was 73.9 % for DA/HA group, and none died during the inductive therapy. LFS and OS was 19.8 months and 12.1 months, respectively. OS rate was 56.58 % at 1 year, 27.1% at 3 years, and 27.1% at 5 years.There were no difference on OS rates between 2 groups (x2 were 0.009, 0.237 and 1.807, respectively,P ＞0.05). Conclusion In patients who were unfit for intensive chemotherapy, sequential therapy with LD-HA and standard induction improved the rate of complete remission and the duration of survival.

Vaccination is considered a promising alternative for controlling tick infestations. Haemaphysalis longicornis midgut proteins separated by SDS-PAGE and transferred to polyvinylidene difluoride (PVDF) membrane were screened for protective value against bites. The western blot demonstrated the immunogenicity of 92 kDa protein (P92). The analysis of the P92 amino acid sequence by LC-MS/MS indicated that it was a H. longicornis paramyosin (Hl-Pmy). The full lenghth cDNA of Hl-Pmy was obtained by rapid amplification of cDNA ends (RACE) which consisted of 2,783 bp with a 161 bp 3' untranslated region. Sequence alignment of tick paramyosin (Pmy) showed that Hl-Pmy shared a high level of conservation among ticks. Comparison with the protective epitope sequence of other invertebrate Pmy, it was calculated that the protective epitope of Hl-Pmy was a peptide (LEEAEGSSETVVEMNKKRDTE) named LEE, which was close to the N-terminal of Hl-Pmy protein. The secondary structure analysis suggested that LEE had non-helical segments within an alpha-helical structure. These results provide the basis for developing a vaccine against biting H. longicornis ticks.
Amino Acid Sequence ; Animals ; Antigens/genetics/*metabolism ; Base Sequence ; Blotting, Western ; Chromatography, Liquid ; *Cloning, Molecular ; DNA, Complementary/genetics ; Epitopes ; Gene Expression Regulation/*physiology ; Ixodidae/genetics/*metabolism ; Molecular Sequence Data ; Tandem Mass Spectrometry

In order to explore tick proteins as potential targets for further developing vaccine against ticks, the total proteins of unfed female Dermacentor silvarum were screened with anti-D. silvarum serum produced from rabbits. The results of western blot showed that 3 antigenic proteins of about 100, 68, and 52 kDa were detected by polyclonal antibodies, which means that they probably have immunogenicity. Then, unfed female tick proteins were separated by 12% SDS-PAGE, and target proteins (100, 68, and 52 kDa) were cut and analyzed by LC-MS/MS, respectively. The comparative results of peptide sequences showed that they might be vitellogenin (Vg), heat shock protein 60 (Hsp60), and fructose-1, 6-bisphosphate aldolase (FBA), respectively. These data will lay the foundation for the further validation of antigenic proteins to prevent infestation and diseases transmitted by D. silvarum.
Animals ; Antigens/*chemistry/immunology ; Arthropod Proteins/*chemistry/immunology ; Electrophoresis, Polyacrylamide Gel ; Female ; Ixodidae/*chemistry/immunology ; Molecular Weight ; Rabbits ; Tandem Mass Spectrometry