There are many differences between cardiac resynchronization therapy (CRT) and conventional pacing therapy in terms of indications and implant techniques. Generally speaking, CRT requires implanting 3 pacing leads in heart failure patients with ventricular dysynchrony. A left ventricular lead is implanted via intravenous coronary sinus. The pacing site of left ventricle has important influence on therapy response. Sometimes open chest implant or other pacing modes are adopted to compensate the anatomical limitation of coronary sinus and its branches. In addition, the pacing sites and modes of right atrium and right ventricle are also under research to further improve CRT response.
Cardiac Pacing, Artificial ; methods ; Electrodes, Implanted ; Heart Atria ; Heart Failure ; physiopathology ; therapy ; Heart Ventricles ; Humans ; Ventricular Dysfunction, Left ; physiopathology ; Ventricular Dysfunction, Right ; physiopathology

BACKGROUND: This study aimed to determine the plasma levels of urokinase-type plasminogen activator (uPA), urokinase-type plasminogen activator receptor (uPAR), D-dimer, IL-6 and TNF-α, and observe the relations among uPA, uPAR, D-dimer, IL-6 and TNF-α in patients with systemic inflammatory response syndrome (SIRS). METHODS: A prospective, clinical case-control study was conducted in patients with SIRS at age of more than 55 years old treated during 2008-2010 at Wuhan Central Hospital. Venous blood samples were collected by routine venipuncture. Eighty-five patients were divided into two groups according to diagnostic criteria of SIRS: SIRS patients from intensive care units (n=50), and non-SIRS patients from medical wards (n=35). Thirty healthy blood donors who visited the General Health Check-up Division at Wuhan Central Hospital served as controls. Excluded from the study were (1) those patients with pregnancy; (2) those with cancer; (3) those died after admission into the ICU in 7 days; (4) those received cardiopulmonary resuscitation; (5) those who had previous blood system diseases; and (6) those with SIRS before admission into the ICU. The levels of uPA, uPAR, D-D, IL-6 and TNF-α in blood were detected by commercial enzyme-linked immunosorbent assay (ELISA) kit. The data were analyzed using SPSS version 17.0 and expressed as mean ± standard. Student's t test and the Mann-Whitney U test were used in the analysis. The relations of uPA, uPAR and D-dimer, IL-6 TNF-α levels were analyzed using Spearman's rank-order correlation coefficient test. RESULTS: The plasma levels of uPA , uPAR, D-dimer,IL-6 and TNF-α in the patients with SIRS were obviously higher than those in the non-SIRS patients and controls (P<0.001). Correlation analysis showed a positive correlation between uPAR and IL-6 levels (r=0.395, P=0.004) and between uPAR and TNF-α levels (r=0.606, P<0.001), but no correlation between uPAR and D-dimer levels (r=0.069, P=0.632). No correlation was observed between uPA, D-dimer, IL-6 and TNF-α levels (P>0.05). The establishment of ROC curve was based on the levels of uPAR, D-dimer, IL-6 and TNF-αin 24 hours for the diagnosis of multiple organ dysfunction syndrome (MODS), and the ROC areas under the curve were 0.76, 0.58, 0.86 and 0.83, respectively. CONCLUSIONS: uPA and uPAR play a major role in patients with SIRS in the process of coagulation disorder, but the mechanism of SIRS is not the same. uPAR may play a central role in the development of SIRS to MODS.

BACKGROUND:Urokinase-type plasminogen activator (uPA) and urokinase-type plasminogen activator receptor (uPAR) are known as important factors, which mediate a variety of functions in terms of vascular homeostasis, inflammation and tissue repair. However, their role in systemic inflammatory response syndrome (SIRS) has been less well studied. This study aimed to test the hypothesis that the abnormalities of fibrinolysis and degradation of extracellular matrix mediated by uPA and uPAR are directly related to the patients with SIRS. We therefore analyzed their role and clinicopathological significance in patients with SIRS.METHODS:A case-control study was conducted with 85 patients who were divided into two groups according to the diagnostic criteria of SIRS:SIRS group (n=50) and non-SIRS group (n=35). The SIRS group was divided into MODS group (n=26) and non-MODS group (n=24) by their severity, and survival group (n=35) and non-survival group (n=15) by their prognosis. Another 30 healthy adults served as normal controls. uPA and uPAR in plasma were detected by commercial enzyme-linked immunosorbent assay (ELISA) kits.RESULTS:The plasma level of uPA was lower in the SIRS group than in the non-SIRS group and controls (P<0.001 andP<0.001). It was lower in sepsis patients and the MODS group than in the non-sepsis patients and the non-MODS patients (allP<0.05). However, there was no difference in uPA level between survivors and non-survivors (P>0.05). The plasma level of uPAR increased in the SIRS group compared with the non-SIRS group and controls (P<0.001 andP<0.001). There was a significant elevation of uPAR in sepsis patients, MODS patients and non-survivors as compared with non-sepsis patients, non-MODS patients and survivors respectively (allP<0.05). Plasma uPAR levels were positively correlated with APACHE II score (r=0.575,P<0.001) and SOFA score (r=0.349,P=0.013). AUCs for the prediction of SIRS mortality were 0.67 and 0.51, respectively, for uPA and uPAR.CONCLUSION:uPAR could be a predictor of poor outcome in patients with SIRS.

OBJECTIVETo investigate the qualitative diagnosis method of atlanto-axial tuberculosis and the corresponding therapeutic strategy.

METHODSTwenty-two cases with atlanto-axial tuberculosis proven by histopathologic diagnosis were observed. Three cases and 17 cases underwent trans-oral biopsy and CT-guide percutaneous biopsy respectively, 2 cases were conformed by frozen section in operation. Thirteen of the 22 cases underwent surgical therapy: 1 case with anterior trans-oral radical eradication and fusion under Halo-vest immobilization, 7 cases with anterior cervical radical eradication, 1 case with anterior interbody fusion and titanic plate fixation, 2 cases were with posterior atlantoaxial interlaminar fusion and 2 cases with posterior cervical occipito-axial titanic plate internal fixation and fusion. Other 9 cases accepted nonsurgical therapy: 8 cases with Halo-vest immobilization and 1 case with head halter traction. All cases were given appropriate antituberculotic chemotherapy for 12-18 months.

RESULTSAll of the 22 cases were followed up, and the average time was 37 month. The lesion focus showed reparation and fusion in X-ray, and the results were satisfactory.

CONCLUSIONSBiopsy can acquire the qualitative diagnosis on atlanto-axial tuberculosis. The choice of therapy is made on the situation of cold abscess, pathological fracture, atlanto-axial dislocation and spinal cord compression.

Adolescent ; Adult ; Antitubercular Agents ; therapeutic use ; Atlanto-Axial Joint ; pathology ; Biopsy, Needle ; methods ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Spinal Fusion ; Tuberculosis, Spinal ; diagnosis ; pathology ; therapy

OBJECTIVETo observe the effect of Uighur medicine gu-jing-mai-si-ha tablet (GJMSHT) for treatment of premature ejaculation (PE) and to explore part of its mechanism.

METHODSThe condition of patients was scored by related questionnaire, and the intravaginal ejaculation latency time (IELT) was observed before and after GJMSHT treatment, with the blood levels of nitric oxide (NO) and prostaglandin F2alpha (PGF2alpha) detected in PE patients as well. The results were compared with those in the control group.

RESULTSAfter treatment, the scores of PE and IELT, as well as the levels of NO and PGF2alpha, all increased significantly compared to those before treatment in the treated group (P<0.01), while in the control group, all the parameters were insignificantly changed (P>0.05). Therefore, the difference of these parameters between the two groups after treatment all showed statistical significance (P<0.01).

CONCLUSIONGJMSHT could treat PE effectively, its mechanism is possibly by strengthening the coordination of the related smooth muscles through increasing the blood levels of NO and PGF2alpha, and the endurance of patients to the cavitary effect of prostatico-urethral pressure, thus postponing the arrival of urgent ejaculatory feeling.

Adult ; Dinoprost ; blood ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Ejaculation ; drug effects ; Female ; Humans ; Male ; Nitric Oxide ; blood ; Sexual Dysfunction, Physiological ; drug therapy ; physiopathology ; Tablets

In past decade, hydrogen sulfide (H₂S) as a novel gasotransmitter, covered many fields in biological and medical research. However, there is no effective, convenient and high-throughput method for determination of circulatory H₂S until now. Here, we aim to develop an easy method for measurement of circulatory H₂S by modified methylene blue method. In the present study, we added Zn²⁺ to plasma sample to deposit H₂S, HS⁻ and S²⁻, as well as plasma protein, then used NaOH to re-dissolve plasma protein. ZnS deposition was re-dissolved by the addition of N, N-dimethyl-p-phenylenediamine, and the remnant protein was deposited by trichloroacetic acid. After centrifugation, ferriammonium sulfate was added to the supernatant fluid to generate methylene blue, which was analyzed by spectrophotometer at 665 nm. Using the present method, we found that most ions including sulfate and thiosulfate did not affect detection of H₂S concentration, but albumin (physiological concentration) reduced the detection value, which suggested the binding of serum albumin and a certain amount of H₂S. The relative recovery ratio of present method is 81.9%, which implies that the method is relative accurate for the determination of H₂S concentration in plasma or serum. H₂S levels of frozen plasma samples from 65 healthy volunteers detected by the present method were (13.93 ± 4.98) µmol/L. There was no obvious difference between the detection values of fresh and frozen samples from the same SD rats. These results suggest the modified methylene blue assay is stable, sensitive, convenient and high-throughput. The method can be used to analyze the circulatory H₂S in clinical and basic research.
Animals ; Blood Chemical Analysis ; methods ; Humans ; Hydrogen Sulfide ; blood ; Methylene Blue ; chemistry ; Phenylenediamines ; chemistry ; Rats ; Rats, Sprague-Dawley ; Sulfides ; chemistry ; Zinc Compounds ; chemistry

BACKGROUNDEndogenous hydrogen sulfide is a new neuromodulator which takes part in the regulation of central nervous system physiology and diseases. Whether endogenous hydrogen sulfide in the central nervous system regulates cardiovascular activity is not known. In the present study, we observed the hemodynamic changes of hydrogen sulfide or its precursor by intracerebroventricular injection, and investigate the possible roles of endogenous digitalis like factors and sympathetic activity in the regulation.

METHODSNinety-four Sprague-Dawley rats underwent a right cerebroventricular puncture, then the hydrogen sulfide saturation buffer or its precursor injected by intrcerebroventricular catheter. A heperin-filled catheter was inserted into the right femoral artery or into the left ventricle, and changes of blood pressure or cardiac function recorded by a Powerlab/4S instrument. Phentolamine or metoprolol were pre-injected to observe the possible role in autonomic nerve activity. After rats were sacrificed, plasma was collected and endogenous digitalis-like factors were measured with a commercial radioimmunoassay kit. The aortic, cardiac sarcolemmal vesicles were isolated and the activity of Na(+)-K(+)-ATPase was measured as ouabain-sensitive ATP hydrolysis under maximal velocity conditions by measuring the release of inorganic phosphate from ATP. Unpaired Student's t test for two groups or analysis of variances (ANOVA) for multiple groups were used to compare the differences of the changes.

RESULTSIntracerebroventricular injection of hydrogen sulfide induced a transient hypotension, then dramatic hypertenive effects in a dose-dependent manner. Bolus injection of L-cysteine or beta- mercaptopyruvate also increased mean arterial pressure (P < 0.01), whereas hydroxylamine-a cystathionine beta synthase inhibitor decreased the arterial pressure (P < 0.01). Hydrogen sulfide and L-cysteine increased mean arterial pressure, left ventricular develop pressure and left-ventricle maximal rate of systolic and diastolic pressure; these functions were decreased by hydroxylamine (P < 0.01). Glibenclamide (a K(ATP) channel blocker) blocked the transient hypotensive effect, phentolamine (an alpha-adrenergic receptor blocker) blocked the hypertensive effect, and metoprolol (a selective beta 1 receptor blocker) blocked the positive inoptropic effect of central nervous system hydrogen sulfide. The endogenous digitalis-like factors in plasma were elevated (P < 0.01) after treatment with L-cysteine, association with decreasing Na(+)-K(+)-ATPase activity in cardiac or aortic sarcolemmal vesicles (P < 0.01). Hydroxylamine injection reduced the endogenous digitalis-like factors level in plasma association with increasing Na(+)-K(+)-ATPase activity in cardiac and aortic sarcolemmal vesicles.

CONCLUSIONCentral nervous system endogenous hydrogen sulfide upregulated mean arterial pressure and cardiac systolic function by activation of sympathetic nerves or release of endogenous digitalis-like factors.

Animals ; Blotting, Western ; Cardenolides ; metabolism ; Central Nervous System ; drug effects ; metabolism ; Cystathionine beta-Synthase ; metabolism ; Cysteine ; analogs & derivatives ; pharmacology ; Hemodynamics ; drug effects ; Hydrogen Sulfide ; metabolism ; pharmacology ; Male ; Radioimmunoassay ; Rats ; Rats, Sprague-Dawley ; Saponins ; metabolism ; Sodium-Potassium-Exchanging ATPase ; metabolism ; Sulfurtransferases ; metabolism

OBJECTIVETo investigate the expression of CK19 in HBV-related hepatocellular carcinoma (HCC) tissues in patients with low serum AFP concentration and the relationship between them and the recurrence and prognosis of HCC after R0 radical hepatectomy.

METHODSThe expressions of CK19 and Ki67 in HCC tissues of 235 cases were examined using tissue microarray and two-step methods of PV-6000 immunohistochemistry. The expression of CK19 mRNA in 20 frozen HCC specimens was examined by RT-PCR. The correlation between gene expressions and tumor recurrence and prognosis was analyzed.

RESULTSAmong the 235 HBV-related HCC patients after R0 radical hepatectomy, the median disease-free survival (DFS) was 31.2 months in the patients with serum AFP < 400 µg/L and 13.8 months in the patients with serum AFP ≥ 400 µg/L (P = 0.041), the overall survival (OS) was 84.0 and 58.6 months in the two subgroups (P = 0.125), and the tumor recurrence within one year was in 43 cases (27%) and 37 cases (49.3%), respectively, (P = 0.001). The DFS was 11.6 months in the CK19-positive cases and 27.0 months in the CK19-negative cases (P > 0.05). The OS was significantly lower in the CK19-positive cases than that in the CK19-negative cases (P = 0.023). Both DFS and OS in the CK19-positive cases with AFP < 400 µg/L were significantly lower than those in the CK19-negative cases with AFP < 400 µg/L (both P < 0.05). The CK19 expression was significantly correlated with histological differentiation (P = 0.023), number of tumor foci (P = 0.044), vascular tumor embolism (P = 0.005), regional lymph node metastasis (P = 0.023), and 1-year recurrence (P = 0.006). Among the patients with AFP < 400 µg/L, the 1-year recurrence was 53% in the CK19-positive cases and 23% in the CK19-negative cases (P < 0.001), the median DFS was 11.3 months in CK19-positive cases and 34.0 months in CK19-negative cases (P = 0.010), and the median OS was 19.5 months in the CK19-positive cases, significantly lower than 84.0 months in the CK19-negative cases (P = 0.001). Cox regression analysis showed that CK19-positive expression was an independent factor affecting early HCC recurrence and prognosis.

CONCLUSIONIn HBV-related HCC patients after radical hepatectomy with AFP < 400 µg/L, positive expression of CK19 indicates a higher proliferation and invasiveness of HCC, and is an important factor of early recurrence and poor prognosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; metabolism ; pathology ; surgery ; virology ; Disease-Free Survival ; Female ; Hepatectomy ; methods ; Hepatitis B virus ; Humans ; Keratin-19 ; genetics ; metabolism ; Liver Neoplasms ; metabolism ; pathology ; surgery ; virology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; RNA, Messenger ; metabolism ; Survival Rate ; Young Adult ; alpha-Fetoproteins ; metabolism

Many epidemiologic and clinical studies have indicated that the frequency of breast cancer was lower in parous women than in nulliparous women. Moreover, the incidence of breast cancer has been reported to be lower in women with early childbirth than in women with late childbirth. To verify the effect of childbirth and the age at first childbirth on carcinogenesis and progression of breast cancer, we induced breast cancer by 7,12-dimethylbenanthracene (DMBA) in 120 female Sprague-Dawley (SD) rats, and divided them into control or experimental (DMBA-treated) nulliparous, early childbirth, and late childbirth groups to observe the incidence, latency, and size of breast cancer. Argyrophilic nucleolar organizer regions (AgNOR) count and the expression of C-erbB-2, proliferating cell nuclear antigen (PCNA), Ki-67, and minichromosome maintenance protein 2 (MCM2) in breast cancer tissues were detected by immunohistochemistry. The breast cancer incidences were 95.0%, 16.7%, and 58.8% in the experimental nulliparous, early childbirth, and late childbirth groups, respectively (all P < 0.05). Between any two of these groups, the latency was significantly different, but tumor size was similar. AgNOR count and the expression of C-erbB-2, PCNA, Ki-67, and MCM2 were significantly higher in the experimental nulliparous group than in the experimental early or late childbirth groups (P < 0.05), but no significant differences were observed between the latter two groups. Taken together, the results suggest that childbirth, especially early childbirth, can reduce the incidence and postpone the onset of DMBA-induced breast cancer.
9,10-Dimethyl-1,2-benzanthracene ; Animals ; Antigens, Nuclear ; metabolism ; Carcinogens ; Cell Transformation, Neoplastic ; Female ; Ki-67 Antigen ; metabolism ; Mammary Neoplasms, Experimental ; chemically induced ; metabolism ; pathology ; physiopathology ; Minichromosome Maintenance Complex Component 2 ; Nuclear Proteins ; metabolism ; Parity ; Pregnancy ; Proliferating Cell Nuclear Antigen ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Receptor, ErbB-2 ; metabolism ; Tumor Burden

Objective:To observe the effect of Lafosse I subscapularis lesion repair on the reconstruction of anterosuperior rotator cufftear.Methods:A retrospective analysis was performed on patients who underwent surgical treatment of the supraspinatus torn combined with Lafosse I subscapularis lesion from January 2016 to October 2017. It was divided into two groups according to the subscapularis lesion was repaired or not. There were 16 cases in non-repaired group, 7 males and 9 females, aged from 48 to 75 years (average, 59.3 years). In this group, supraspinatus repair and subscapularis debridement with no repair were done. There were 13 cases in repaired group, 5 males and 8 females, aged from 45 to 72 years (average, 57.2 years). In this group, both supraspinatus and subscapularis were repaired. MRI was performed at last follow-up. The pain analogue scale (VAS), American Shoulder & Elbow Surgeons (ASES) score, Constant-Murley score and range of motion (ROM) were recorded at the last follow-up. Patients' satisfaction was recorded.Results:Twenty-nine patients had been followed up. Patients in non-repaired group were followed up 15.9±3.9 months (range 10-22 months), and patients in repaired group were followed up 16.9±3.4 months (range 10-21 months). At the last follow-up, VAS, ASES score, and Constant-Murley score of non-repaired group were 1.1±1.1, 88.4±4.0 and 85.9±3.2 respectively. VAS, ASES score, and Constant-Murley score of repaired group were 0.9±1.1, 89.6±2.9 and 87.5±2.6 respectively. VAS ( t=0.342, P=0.735), ASES score ( t=-0.941, P=0.355) and Constant-Murley score ( t=-1.392, P=0.175) showed no significant difference between non-repaired group and repaired group. At the last follow-up, forward flexion of affected shoulder in non-repaired group was 150.3°±17.3°, external rotation was 41.6°±16.0°, and internal rotation was L 2 level; Forward flexion in repaired group was 148.1°±16.3°, external rotation was 43.9°±9.2°, and internal rotation was L 1 level, which were improved significantly compared with those pre-operation. Forward flexion, external rotation, and internal rotation showed no statistically significant difference between non-repaired group and repaired group. 3 patients were found to have rotator cuff re-tear by MR examination. The re-tear rate was 10.34% (3/29). There were 2 cases in non-repaired group and 1 case in repaired group. At the last follow-up, the ASES score of re-tear patients was 85.3±3.1, which was better than preoperative 41.0±5.2 ( t=12.74, P<0.001). Forward flexion 131.67°±5.8° was better than preoperative 81.7°±11.5° ( t=6.708, P<0.001). One re-tear patient (in non-repaired group) received reoperation and got pain relief. The satisfaction of non-repaired group and repaired group were 93.7% and 92.3%, respectively. Conclusion:For type I subscapularis lesion combined with supraspinatus injury, wheter type I subscapularis lesion was repaired or notdidn't affect the repair effect of the anterosuperior rotator cuff tear in short-term follow-up.