Objective To evaluate the outcome of percutaneous intervention for the diseased bypass grafts in patients with previous coronary artery bypass graft surgery (CABG).Methods Sixty-six patients with diseased grafts after CABG underwent percutaneous intervention between July 2003 and July 2004.Angiographic follow up was suggested to all patients and major adverse cardiac events(MACE,including death,acute myocardial infarction and target lesion revascularization)were recorded within 6 months of follow up.Results Sixty-six patients with 74 diseased grafts(83 lesions) underwent percutaneous intervention.The angiographic success rate was 96.97%((64/66)) and the procedural success rate was 95.45%(63/66).No reflow phenomenon occurred in 2 cases,1 case restored TIMI 3 flow after administering verpamil but the other patient failed to restore the blood flow. Distal embolization occurred in 1 case.Abrupt closure in 1 case because of Dtype dissection not treated during the procedure but TIMI 3 flow was obtained after repairment with another stent.No MACE(death,acute myocardial infarction and acute emergency revascularization) occurred during hospitalization and the incidence of MACE was 31.3%(20/64) at 6 months follow up.In-segment restenosis rate was 32.5%(13/40) in 37 patients with angiographic follow-up.Conclusion Percutaneous intervention for diseased bypass grafts is feasible,safe and effective.

Practical teaching is an important component of higher medical education. The article introduced a number of exploration and experience of Shaoyang Medical College in building a practical teaching quality guarantee system,such as revising personnel training programs, optimizing practice teaching environment,enhancing teaching quality construction projects, strengthening teachers troop construction reinforcing teaching practice management and the teaching quality monitoring,etc.

BACKGROUND: Atlantoaxial posterior approach is currently the main surgical treatment for atlantoaxial instability and/or dislocation, but the shape of rod in normal screw-rod device system is cylindrical. To obtain satisfactory reduction of atlantoaxis, the rod will be pre-bent obviously before fixation; however, the cylindrical rod will be rotated when tighten the nuts. Extra devices will be required to adjust and maintain the direction of the rod, thereafter, the surgical field will be blocked by the device, and spinal injury will occur once the devices are not held tightly. While the novel automatic anti-rotation rod has the function of anti-rotation during nut-tightening process, and also holds all the advantages of normal rod. Further research should be performed for the differences in biomechanical characteristics between two methods.OBJECTIVE: To investigate the biomechanical properties of the novel automatic anti-rotation rod for internal fixation system of atlantoaxial posterior approach based on three-dimensional finite-analysis model of upper cervical spine.METHODS: The three-dimensional finite element model of upper cervical spine with internal rod fixation system was developed. The biomechanical characteristics of the internal fixation system were analyzed. RESULTS AND CONCLUSION: The traditional and novel three-dimensional finite element model with realistic and geometric similarity contained 198330 elements, 964747 nodes and 246788 elements, 996069 nodes,correspondingly. There was no obvious stress concentration in both two systems, stress was concentrated mainly in the screw-bone and screw-rod interfaces. The stress values of the novel system were higher than those of the traditional system, but the maximum Von Misses Stress of two systems was lower than the yield (795-827 MPa ) and ultimate (860-896 MPa) strength of titanium alloys. These results show that the design of the novel automatic anti-rotation rod-screw fixation system has matched the biomechanical requirements for new internal fixation instruments, and is one safe, effective and practical device for atlantoaxial posterior procedure showing promising application prospect.

BACKGROUND:Drug eluting stents(DESs)has been applied in treatment of saphenous vein grafts,but few reports are present.OBJECTIVE:To retrospectively compare the late loss and major adverse cardiac events(MACE)between DES and bare mental stents(BMS)in patients with diseased saphenous vein grafts.DESIGN,TIME AND SETTING:The experiment,a grouping control study and follow-up observation,was performed from January 2002 to February 2007 in Beijing Luhe Hospitat and Beijing Anzhen Hospital.PARTICIPANTS:Ninety-seven consecutive patients with saphenous vein graft lesions were treated with DESs (DESgroup.n=50)or BMSs(BMS group,n=47).METHODS:All patients underwent percutaneous coronary implantation and received clinical follow-ups immediately.They were scheduled to undergo 12-month coronary angiography.MAIN OUTCOME MEASURES:The cardiac events including death,myocardial infarction,target lesion and/or target vessel revascularization.Late lumen loss was recorded and compared between the two groups.RESULTS:There were no significant differences on the gender,age,history of bridge vessels and complication between the two groups(P>0.05).A total of 97 patients with 118 lesions localized in 105 diseased saphenous vein grafts were included:50 patients received 71 DESs for 59 lesions,whereas 47 patients received 62 BMSs for 59 lesions.Procedural success was achieved in 94.0%of patients in the DES group and 93.6%in BMS group(P=0.43).At 12 months,the cumulative incidence of MACE was significantly lower in DES group than in BMS group(1 2.0%vs.29.8%.P=0.03).Angiographic follow-up was available for 54 patients,26 patients in DES group and 28 in BMS group.Late lumen loss was significantly reduced in DES group[(0.32±0.65)mm vs.(0.79±1.23)mm,P=0.01].The DES group had a significantly lower incidence of target lesion revascularization compared with BMS group(6.0%vs.19.1%.P=0.05).By Cox regression analysis,independent predictors for MACE at 12-month follow-ups were diabetes (OR:2.37;CI:0.95 to 5.88;P=0.064),BMS(OR:2.86;CI:0.98 to 8.34;P=0.05),and stent per lesion(OR:2.92;CI:1.25 to 6.82;P=0.01).CONCLUSION:DES is superior to BMS in diseased saphenous vein grafts,and it can significantly reduce late lumen loss and MACE.

Aim To establish an ideal hyperlipidemia animal model by a new way.Methods 30 mice were randomly divided into control group, positive control group and model group.The mice of control group were only fed with a standard diet.Those of positive control group were fed with high fat diet.Those of model group were fed with a standard diet and enough milk.After 30 days the TG, TC, HDL-C and LDL-C of serum and hepatic and LI were detected and pathological changes in the liver of mice were observed microscopically.Results Compared with the control group, the mice of model group developed hyperlipidemia with LI and the serum and the hepatic TG, TC, LDL-C elevated significantly, while HDL-C were significantly lower.The histopathological research showed hepatocellular macrovesicular steatosis and hepatitis in the model group.Conclusion An ideal model of hyperlipidemia is successfully established with standard diet and milk fed to mice for 30 days.

BACKGROUND:Condylar fracture can occur under direct and indirect forces, and however, its risk and correlation with the impact site are rarely reported. OBJECTIVE:To quickly establish normal mandible three-dimensional finite element model and to analyze the strain conditions of the condyle under force at different parts of the mandible. METHODS: An adolescent volunteer was examined by multilayer spiral CT scans, whose mandible was normal and oral cavity was healthy. We used the reverse engineering software Mimics and large finite element software MSC.Patran to establish the three-dimensional finite element model of the mandible and to verify the feasibility of the model in the impact test at the body of the mandible, chin, mandibular angle and condyle. RESULTS AND CONCLUSION:A rapid establishment of mandible dimensional finite element biomechanical model could reproduce the morphology of the mandible, which was able to obtain the overal visual impression of the mandibular condyle. Geometric model included 80 044 nodes and 18 441 units. The mandibular chin, one side of the body, mandibular angle and condyle were given 100 N force respectively. The maximum equivalent stress of the bone cortex appeared in condylar region. So the mandibular condylar fractures were at the greatest risk. Experimental results contribute to mechanicaly analyze the condylar fracture type and to judge the severity of fractures.

Background and purpose: Short tandem repeats (STR) multiplex PCR fluorescence detection technology is the most widely used DNA technology in individual identity and genetic identification. It's the most direct method to obtain accurate conclusions. However, some studies have indicated that the rate of STR mutations in tumor tissue is significantly higher than that in normal tissues or blood. This study aimed to investigate the tendency of genetic instability in 20 STR loci on autosomal and Amel loci in tumor tissue samples from lung cancer. Methods: This study, collected 75 cases of human lung cancer tissues and the adjacent normal tissues. DNA samples were extracted by tissue DNA extraction kit, amplified using MicroreaderTM 21 Direct ID System PCR amplification kit. Capillary electrophoresis was performed using API 3130 analyzer, and results were analyzed by genetic analysis software (Gene Mapper ID V3.2). Results: STR alterations were detected in 24 specimens from 75 lung cancer tissues (32%). Fifty-five alterations were detected in the frequently used 21 STR loci in total, including additional alleles 10 times, loss of heterozygosity 10 times, partial loss of heterozygosity 35 times. Partial loss of heterozygosity was the most common genetic alteration types accounting for 63.64% of the total alteration frequency. And multiple genetic alteration types could occur in the same lung cancer tissue. Among them, the highest alteration frequency occurred on D5S818 (7 times), secondly on D3S1358 and D12S391 (both 5 times), and no alterations on D2S441 and Penta E. Combining the experimental results and analysis on clinical data, this study found the statistical differences between the staging of lung cancer and the age of the patients with the STR loci alterations (P<0.05). However, the alterations did have much relationship with the classification of lung cancer and the patient's gender (P>0.05). Conclusion: STR loci of the lung cancer tissue were not stable, and the alteration occurred in the aged or high malignant degree lung cancer tissue more frequently. Meanwhile, no alteration was detected on D2S441 and Penta E. In the future research the two STR loci should be verified to determine whether they can be used as the stable STR loci in such cases by increasing the sample size.

Objective To explore the best range of international normalized ratio for anticoagulation treatment after mitral valve replacement (MVR) and double valve replacement (DVR).Methods We conducted a follow-up study involving 1592 patients who received the warfarin anticoagulant therapy after MVR or DVR in our hospital.Clinical data was collected including the admission information,the dose of warfarin and the INR level,and the occurrence of bleeding and thrombosis were recorded.The patients were divided into 2 (MVR and DVR) groups in terms of the different valve prostheses,and then each group was assigned to four subgroups according to their INR level ( A:INR=1.4-1.7;B:INR=1.7-2.0;C:INR=2.0-2.3;and D:INR=2.3-2.6) to compare the incidence of bleeding and thrombosis among these subgroups.Results The analysis of the incidence of bleeding:In MVR group,the subgroups with different INR levels had significant difference with participants with INR level at D having higher incidence of bleeding than the other 3 groups (Group A:x2=17.991,Group B:x2=13.436,Group C:x2=7.186;P＜0.01 ).We observed significant difference in DVR groups (x2=19.067,P＜0.01 ) with the increased incidence of bleeding of INR level at D compared with the other three groups ( Group A:x2=16.736,Group B:x2=10.486,Group C:x2=7.773;P＜0.01 ).The analysis of the occurrence of thrombosis;The groups of MVR and DVR had no significant differenceson in the incidences of thrombosis in all the levels of INR ( P ＞ 0.05 ).No significant statistical differences were found on the incidence of bleeding and thrombosis at INR level 1.4-2.3 ( P ＞ 0.05 ) Conclusion The present study suggestes that the level of INR at 1.4-2.3 is appropriate after the anticoagulation therapy in the MVR and DVR groups.

OBJECTIVE: To analyze the characteristics of vestibular migraine (VM), in order to understand the auditory and vestibular function. METHOD: One hundred cases of confirmed or suspected VM patients were observed. Routine examination including pure tone test, vestibular dual temperature test and vestibular evoked myogenic potential(VEMP) and video head impulse test(v-HIT) Were conducted. RESULT: The incidence of male and female was about 1.00 : 2. 57. The average age of onset was 47 years, of which the youngest was 19 years old, and the oldest was 74 years old. Ninty-three cases of patients presented with vestibular sensitive performance, including photophobia, phonophobia,or motion sensitive. Fourty-two patients had migraine at the onset of the disease. Thirty-four patients had cochiear symptoms, including tinnitus, ear fullness, or epicophosis. In seventeen cases of fatigue, tension or poor sleep can cause vertigo. Nine patients had low blood pressure, 7 patients presented with hypertension. Two cases of vertigo were closely related to the change of position, and 1 case had visual aura. In the experiment, 94 patients had undergone VEMP test,with 44 cases of abnormal VEMP value. Seventy-nine patients had been examined v-HIT,of whom 2 patients were abnormal (both of which were reduced). Pure tone audiometry was abnormal in 35 cases. Five cases of patients showed abnormal vestibular-double temperature test. CONCLUSION Vestibular migraine is more prone to female, with young middle age, and can be accompanied by cochlear symptoms. Vestibular function tests (low frequency and high frequency) are normal.
Adult ; Aged ; Audiometry, Pure-Tone ; Evoked Potentials ; Female ; Head Impulse Test ; Humans ; Male ; Middle Aged ; Migraine Disorders ; diagnosis ; Vestibular Function Tests ; Vestibule, Labyrinth ; physiopathology ; Young Adult

Objective To evaluate the biomechanical characteristics and the clinical advantage of transoral atlantoaxial reduction plate(TARP)Ⅲ.Methods Design of TARP-Ⅲ was based on TARP-Ⅱ.The screw hole in the axis was moved 1-2 mm upwards and inwards in a plate which turned a vertebral screw into a pedicle screw or an articular process screw.A polyaxial self-lock ring and polyaxial guiding drill were added to the crew hole of the plate.Finally,the withdrawal resist ence force of the three axis screws was tested and TARP-Ⅲ was used in 44 patients with complicated irreducible atlantoaxial dislocation.The axis was fixed with the pedicle screw or the articular process screw.Results The maximum withdrawal resist ence force of the anterior pedicle screw,the articular process screw and the vertebral screw in the axis was(593.1 ± 97.8)N,(469.9 ± 73.3)N and(395.2 ± 75.1)N respectively,with statistical difference between groups among three fixation methods(P ＜ 0.05).All 44 patients were followed up for 5-38 months(average 18 months),which showed complete anatomic reduction in 36 patients and appropriate anatomic reduction in eight,with basic correction of the angles between the brain stem and the spinal cord and sufficient decompression of the spinal cord.The decompression rate of the cervical spinal cord was average 88.2% according to the Yin evaluating method of cervical cord decompression.The improvement rate of spinal cord function was average 76.6% according to Japanese Orthopaedic Association(JOA)score.Conclusion With the design of polyaxial self-lock mechanism,TARP-Ⅲ with the pedicle screw or the articular process screw surpasses TARP-Ⅱ with vertebral screw in aspect of biomechanics.