Objective To investigate the role of titanium plate fixation for sternum closure after off-pump coronary artery bypass grafting (OPCABG) in elderly patients.Methods A total of 120 elderly patients who accepted OPCABG were randomly divided into two groups.The control group (n =60) received wire to fix the sternum,and the experimental group (n=60) received titanium plate combined with wire to fix the sternum.The chest closure time,the rate of postoperative incision pain,the rate of sternal dehiscence and sternal re-fixation between two groups were observed and recorded.Results The rates of postoperative incision pain,sternal dehiscence,sternal re-fixation was lower in experimental group than in control group [11.7％(7/60) vs.38.3％(23/60),3.3％(7/60) vs.13.3％(8/60),1.7％(1/60) vs.11.7％(7/60),x2 =11.378,3.927,4.821 respectively all P＜0.05].The chest closure time was longer in experimental group than in control group [(39±5)min vs.(30±2) min,x2 =13.386,P＜0.05].Conclusions Titanium fixation plate combined with wire for sternum closure can increase the stability of sternum fixation,reduce the postoperative pain and sternal dehiscence,and then decrease the risk of sternal re-fixation,but delay sternal closure of OPCABG in the elderly.

Objective To explore the effect of pleural cavity integrity on respiratory system after off-pump coronary artery bypass grafting (OPCABG),through comparing the respiratory complication after OPCABG.Methods One hundred and two patients were accepted OPCABG,among whom 49 patients' pleural cavities were opened (open group) and 53 patients' pleural cavities were closed (close group).The ventilation time,intensive care unit time,pleural effusion,the rate of atelectasis and respiratory failure after operation were compared between two groups.Results The ventilation time and intensive care unit time in open group were (40.3 ± 4.8) h and (78.3 ± 10.8) h,in open group were (28.6 ± 6.8) h and (54.8 ± 6.1) h.The ventilation time and intensive care time in open group were significantly longer than those in close group(P ＜ 0.01 or ＜ 0.05).The pleural effusion in open group was (800.0 ± 60.5) ml,in close group was (350.0 ± 28.6) ml.The pleural effusion in open group was significantly higher than that in close group (P ＜ 0.01).The rate of postoperative atelectasis and respiratory failure in open group were 36.7％(18/49) and 38.8％(19/49),in close group were 15.1％(8/53) and 18.9％(10/53).The rate of postoperative atelectasis and respiratory failure in open group were significantly higher than those in close group (P ＜ 0.01).Conclusions OPCABG is the operation in mediastinum.To avoid pleural cavity opened in OPCABG can reduce the incidence of postoperative respiratory complication.

Objective To investigate the effects of aldosterone on the expression of endothelin(ET)in cultured neonatal rat cardiac fibroblasts(CFs).Methods CFs were isolated by trypsin digestion.ET concentration in conditioned medium was measured by radioimmunoassay,intracellular ET-1 level was evaluated by immunofluorescence assay,and the expression of preproendothelin-1(ppET-1)was detected using reverse transcriptase-polymerase chain reaction(RT-PCR)method.Results Aldosterone(10-9,10-8,10-7 mol/L)induced a dose-dependent changes in ppET-1 mRNA expression,as well as ET-1 synthesis and secretion in CFs.Meanwhile,aldosterone(10-7 mol/L)time-related induced ppET-1 mRNA expression in CFs,which began to increase in 2 h and reached the highest level in 4 h,thereafter decreased.The effects of aldosterone(10-7 mol/L)were significantly inhibited by the pre-incubation with spironolactone(10-6 mol/L).Conclusion Aldosterone increases the expression of ppET-1 mRNA,ET-1 synthesis and secretion via mineralocorticoid receptor.

Objective To assess the feasibility of anticoagulation therapy after mechanical valve replacement in grass-root health institutions.Methods One hundred and sixty one patients with mechanical valve replacement received anticoagulation therapy with warfarin,including 79 cases receiving the therapy in grass-root health institutions (test group) and 82 cases in the tertiary hospitals (control group).The patients were followed up for 12 months after operation;the rate of anticoagulation efficacy,the anticoagulationrelated complications,and the anticoagulation-related cost were documented and compared between two groups.Results The international normalized ratio (INR) tests were performed for 1 021 times in test group and 717 times were up to anticoagulation standard (70.2 ％,717/1 021),while INR tests in control group were performed for 965 times and 688 times were up to standard (71.3％,688/965);there were no significantly differences in efficacy rate between two groups (P ＞ 0.05).There were no significant differences in rate of bleeding events and thrombosis between two groups [16.5％ (13/79) vs.12.2％ (10/82),6.3％(5/79) vs.4.9％(4/82),respectively,x2 =0.596,P=0.44,x2 =0.161,P=0.69].The anticoagulation-related cost per month and per patient in test group was significantly lower than those in control group [(63.1 ±.12.8) vs.(176.6 ± 16.4) yuan,t =48.716,P ＜0.05].Conclusion Compared with the tertiary hospital,the anticoagulation therapy in grass-root institutions can accomplish the similar clinical outcomes and significantly reduce the medical cost in patients with mechanical valve replacement.

Aims Toevaluatethepharmacodynamic efficacy of different types of antiangiogenic agents as HM-3 on a non-small cell lung cancer xenografts tumor model .To explore the interaction between the antian-giogenic agents and the tumor microenvironment,and to offer suggestions for clinical therapy.Methods Thenon-smallcelllungcarcinomaxenograftmodelwas established in Balb/c nude mice.The model mice were treated with Docetaxel(10 mg·kg-1 )as the positive control.The mice were parallelly treated with,HM-3 at the doses of 3 mg · kg-1 and 48 mg · kg-1 and, Avastin(5 mg·kg-1 ).The parameters include tumor volume,tumor weight and immunohistochemical analy-sis.Result Animalexperimentsshowedthatdocetaxel had good anti-tumor activity.Tumor growth inhibition by tumor weight of G2 docetaxel(10 mg·kg-1 )group was 60. 80%.Tumor growth inhibition by tumor weight of G3 HM-3(3 mg·kg-1 )group,G4 HM-3(48 mg· kg-1 )group ,G4 Avastin(5 mg·kg-1 )group,were 43. 60%,-34. 80%,44. 40%,respectively.Con-clusion Theantigiogeniceffectisaffectedbytumor growth stage,tumor microenvironment and their work-ing mechanisms.Angiogenesis inhibitors HM-3 has a certain effect of inhibiting tumor growth,but to little a-vail.HM-3 shows on inhibitory effect in a dose-de-pendent manner at the doses of 0~6 mg·kg-1 .HM-3 at a high dose of 48 mg · kg-1 has no inhibitory but promoting effects on human non-small cell lung carci-noma A549 xenografts in nude mice .Special dose-effect relationship indicates that dosage should be paid attention to in the clinical use of blood vessel inhibi-tors.

Objective To investigate the predictive value of metabolic syndrome in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods A total of 660 patients with ACS admited to cardiovascular department,first affiliated hospital of zhengzhou university were enrolled in this study from January 2009 to June 2010.The enrollment criteria were:the stenosis degree were above 75％ in at least one coronary artery by coronary angiography and successful PCI procedure.Exculsion criteria were:liver and renal insufficiency,malignancies and valvular heart diseases.The relevant clinical data and labtory examination were recorded after admission. The patients were followed up by outpatients interview or telephone from March to June 2011 and adverse cardiovascular events were recorded.The patients were divided into MS and non-MS groups,and basic clinical data were compared between two groups.The proportion difference between two groups were tested by chi square. Multivariate logistic regression was established to analyze the factors related to progonosis.The survival ratio was estimated using the Kaplan-Meier method.Statistical significance was established at a P value of less than 0.05.Results ①A total of 606 (91.7％) patients successfully accepted follow-up.Mean follow-up time were ( 14.3 ±1.7 ) months.95 patients experienced adverse cardiovascular events ( 15.7％ ).②There were 393 patients (64.96％ ) satisfied the definition of metabolic syndrome.The patients in MS group were with higher BMI,SBP,DBP,blood glucose and disordered lipid (all P ＜ 0.05 ),with less fale patients (P =0.016),less current somking (P =0.008 ) and with higher platelet (P =0.037 ). The incidence of adverse cardiovascular events in two groups were 17.81％ and 11.79％ ( P ＞ 0.05 ). ③ Multivarite logistic regression revealed that the predictors of adverse cardiovascular events were age [ OR =2.628,95％ confidence interval (CI) 1.395 ～ 4.954,P =0.003 ],New York Heart Association (NYHA) ≥ 3 grade ( OR =2.310,95％ CI 1.095 ～4.870,P =0.028) and left ventricular ejection fraction (LVEF) ( OR =4.328,95％ CI 1.955 ～9.580,P ＜ 0.001 ).However,MS was not related with prognosis ( OR =1.170,95％ CI 0.583 ～ 2.345,P =0.659 ).④The cumulative survival rates of no adverse cardiovascular events in the two groups were no significant difference ( P ＞ 0.05 ).Conclusions MS is a risk factor with coronary heart disease.Howerer,it has no relationship with adverse cardiovascular events in patients with ACS after PCI.

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on inflammatory responses during intestinal mucosal barrier damage caused by gastrointestinal surgery in the rats.Methods:Forty-five healthy male Sprague-Dawley rats, aged 7-8 weeks, weighing 220-260 g, were divided into 3 groups ( n=15 each) by a random number table method: control group (C group), gastrointestinal surgery group (S group), and TEAS group (T group). Rats underwent pylorectomy and Roux-en-Y gastrojejunal anastomosis to establish gastrointestinal surgery models in S and T groups, while group C received no treatment.In group T, bilateral Zusanli and Hegu acupoints were stimulated with disperse-dense waves, current intensity 5 mA, frequency 2 Hz, from 30 min before surgery until the end of operation.Only electrode patches were applied, but no stimulation was applied in group S. Five rats were randomly selected from each group and sacrificed at 12, 24 and 48 h after surgery (T 1-3), and ileal tissues were taken after anesthesia.The pathological changes of ileal tissues were observed with a light microscope and scored according to Chiu.Enzyme-linked immunosorbent assay was used to determine contents of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), diamine oxidase (DAO) and intestinal fatty acid-binding protein (I-FABP). Western blot was used to detect the expression of occludin, claudin-3 and ZO-1.The immunohistochemical method was used to determine the percentage of occludin, claudin and zonula occludens-1 (ZO-1) positive cells. Results:Compared with group C, Chiu′s scores and contents of ileal IL-6, TNF-α, DAO and I-FABP were significantly increased, the percentage of occludin, claudin-3 and ZO-1 protein positive cells was decreased, and the expression of occludin, claudin-3 and ZO-1 was down-regulated at T 1-3 in group S and group T ( P<0.05). Compared with group S, Chiu′s scores and contents of ileal IL-6, TNF-α, DAO and I-FABP were significantly decreased, the percentage of occludin, claudin-3 and ZO-1 protein positive cells was increased, and the expression of occludin, claudin-3 and ZO-1 was up-regulated at T 1-3 in group T ( P<0.05). Conclusion:TEAS can reduce the intestinal mucosal barrier damage caused by gastrointestinal surgery by inhibiting the inflammatory response in rats.

Objective To evaluate the cardioprotection of electroacupuncture (EA) in the patients undergoing heart surgery with cardiopulmonary bypass (CPB).Methods Forty American Society of Anesthesiologists physical status Ⅲ patients,aged 18-55 yr,of New York Heart Association Ⅱ-Ⅲ,scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =20 each) using a random number table:control group (group C) and group EA.In group EA,bilateral Neiguan,Ximen,Shenmen and Baihui acupoints were stimulated with an electrie stimulator with the frequency of 2 Hz from 20 min before anesthesia induction until the end of operation,and the optimal intensity was selected according to the patient's tolerance when awake.Before EA and at 30 min of CPB,30 min,1 h and 2 h after termination of CPB and 6 and 24 h after operation,blood samples were taken from the central vein for determination of concentrations of heart-type fatty acid binding protein and cardiac troponin Ⅰ in plasma (by enzymelinked immunosorbent assay) and concentrations of malondialdehyde (using hydroxylamine method).Cardiac contractility was scored at 1,6 and 24 h after operation,and arrhythmia was scored at 24 h after operation.Results Compared with group C,the plasma concentrations of malondialdehyde at 30 min and 1 and 2 h after termination of CPB and 6 h after operation,plasma concentrations of cardiac troponin Ⅰ at 24 h after operation,and plasma concentrations of heart-type fatty acid binding protein at 30 min of CPB and 24 h after operation were significantly decreased,and the arrhythmia score and cardiac contractility score at 6 and 24 h after operation were decreased in group EA (P＜0.05).Conclusion EA can inhibit lipid peroxidation and exerts cardioprotection in the patients undergoing heart surgery with CPB.

With the discovery of exosomes,new pathways of intercellular information and material exchange mediated by exosomes are attracting more and more attention from researchers. The process of exo-some production overlaps with many viral assembly and outflow pathways,suggesting that exosomes may be related to viral infections. In vitro experiments also show that exosomes play a very important role in viral in-fections. On one hand,exosomes can transfer viral nucleic acids and proteins,and may change microenviron-ment to promote the spread of infection. On the other hand,exosomes can induce immune responses by activa-ting antiviral pathways or transferring antiviral molecules. Do they promote or suppress the spread of infec-tion? What are the factors that affect their functions? In this paper,we review the role of exosomes in viral in-fection in order to provide a reference for better understanding the process of viral infection and immune re-sponses,and to provide a new train of thoughts for the prevention,diagnosis and treatment of viral diseases.

Objective To investigate the efficacy on antibacterial , antipyretic, analgesic, anti-inflammatory and immune reg-ulation of Juhuang Qingre San .Methods Efficacy on antibacterial was evaluated by the method of doubling dilution ,vivo antibacterial effect was observed by inoculating BABL/C mice with Streptococcus pneumonia ,efficacy on antipyretic was investigated by using endo-toxin fever model ,analgesic function was assessed using mice hot plate and torsion analgesic method ,effect of anti inflammatory was as-sessed with rat paw edema model and mice Peritoneal capillary permeability model , the role of regulating immune system was evaluated by mice carbon clearance test .Results Juhuang Qingre San can decrease the death rate of mice in antibacterial test in vitro or vivo,in low and mid dose group of Juhuang Qingre San , heating temperature of rabbits decreased significantly 2-3 h after administration ( P<0.05), and high dosage group decreased significantly 2-4 h after administration (P<0.05),the mice pain threshold increased signif-icantly (P<0.05) after the administration of 1.5, 2, 3 h in every group of Juhuang Qingre San was , and can significantly reduce the number of mice writhing after intraperitoneal injection (P<0.05),rat paw swelling rate decreased significantly 1, 2, 3, 4, 5 h after administration in each dosage group of Juhuang Qingre San (P<0.05), peritoneal capillary permeability decreased in the acute in-flammation model of mice (P<0.05), in carbon particle clearance test of immune regulation , K value of high and medium dose group of Juhuang Qingre San was increased , while the value of alpha increased as well ( P<0 .05 ) .Conclusion The results suggested that Juhuang Qingre San has efficacy of antibacterial , antipyretic, analgesic, anti-inflammatory and immune enhancing .