Objective: To explore the potential influencing factors of the quality guidelines for medical treatment by factor analysis.Method: We analyzed with the SPSS package 9 quality guidelines for medical treatment in the department of integrated TCM and Western medicine of a hospital,including the out-patient person-time,the number of discharges,the average days of hospitalization,the rate of bed utilization,the frequency of bed rotation,the rate of cure and improvement,the case fatality rate,the coincidence rate of diagnoses at admission and discharge,and the success rate of emergency treatment.Results: Four common factors were extracted,namely,the quantifiable factor,determined by the out-patient person-time,the number of discharges,the average days of hospitalization and the frequency of bed rotation;the treatment factor,determined by the cure and improvement rate and case fatality rate;the diagnostic factor,determined mainly by the rate of bed utilization and the coincidence rate of diagnoses at admission and discharge;and the emergency treatment factor,determined by the success rate of emergency treatment.The cumulative contribution rate of the 4 factors was 85.1%.Conclusion: The amount of medical work,the techniques of treatment,the ability of diagnosis and the efficiency of emergency rescue are the main influencing factors of quality guidelines for medical treatment.

Objective To study the perioperative morbidity and mortality of thoraco-abdominal aortic aneurysm ( TAA ) and analyze the relationship between the preoperative or intraoperative risk factors and the morbidity or mortality. MethodsTwenty-three TAA cases undergoing surgery between Jan. 1993 and Dec. 2001 were enrolled. Preoperative cardial, pulmonary, hepatic and renal function, the site and period of intraoperative aortic clamping as well as the emergency operation were taken into account to evaluate independent determinants of the perioperative morbidity and mortality. ResultsThe perioperative morbidity and mortality were 87.0% and 30.4% respectively. As to the morbidity, pulmonary, hepatorenal dysfunction and paraplegia are commonly seen in perioperative period of TAA. Acute renal failure is the most important cause of perioperative death. ConclusionsIntraoperative aortic blocking and massive blood transfusion are the independent determinants influencing perioperative adverse events significantly.

Objective To study operative morbidity and mortality of infrarenal abdominal aortic aneurysm (IAAA) and analyze the correlation between the preoperative or intraoperative risk factors and the morbidity or mortality. Methods Between Jan 1993 and Dec 2001, 120 IAAA cases undergoing surgery were analyzed. Preoperative cardiac, pulmonary, hepatic and renal condition, time of intraoperative aortic clamping as well as emergent operation were taken into account to evaluate the independent determinants of operative morbidity and mortality. Results The operative morbidity was 56.7% and mortality was 10.0%, with the mortality of elective surgery of 5.4% and emergent surgery of 66.7%. Conclusion Preoperative coronary heart disease, hypertention, renal dysfunction and massive blood transfution intra- or postoperatively adversely influenced the postoperative outcome significantly.

Objective To study the expression of polycystin1 and polycystin2 in dissection aorta specimens by Real time PCR and immunohistochemisty. Methods Twelve descending dissection aorta specimens from patients of acute Stanford B dissection were taken during surgery; 12 normal descending aorta specimens were taken from multi-organ donors. The G APDH gene was used as control, gene expression of polycystinl and polycystin2 were compared in these two groups with Real time PCR. The expression of polycystinl and polycystin2 protein were showed with immunohistochemisty in the specimen of these two groups. Three high magnify fields were randomly chosen to count the expression of polycystin1 and polycystin2 protein. The counting of polycystin1 and polycystin2 protein were compared between these two groups. Results The gene expression of polycystinl in AD group is 0. 32 fold as that in the control group (P ＜ 0.01 ) and polyeystin2 in AD group is 0.34 fold as that in the control group (P ＜0.01 ); The protein expression of polyeystinl was 0.47 folds as that in the control group ( P ＜ 0.05 ) and polycystin2 in AD group is 0.35 folds as that in the control group ( P ＜ 0.01 ). Conclusions The expression of polycystin1 and polycystin2 on gene and protein level were down regulated in AD group. The down regulation of polycystinl and polycystin2 may play a pivotal role in the development of AD.

Objective To analyze the diagnostic procedures and treatment strategies in the mycotic aneurysm caused by Salmonella enterica serotype choleraesuis infection in a single medical center. Methods From January 2000 to December 2008, clinical data of 8 cases with infected aneurysm caused by Salmonella enterica serotype choleraesuis were analyzed. Results All cases were treated with endovascular stent-graft treatment, including abdominal aortic aneurysm in six cases, thoracic aortic aneurysm in one, and popliteal artery aneurysm in one case. Six bifurcated stent-graft and two tube stent-graft were used. The surgical success rate was 100% with no perioperative or 30-day mortality nor major morbidity. All of the patients recovered uneventfully and were discharged with oral antibacterial agents. During mid-term follow up (range 15-36 months), four patients are alive and well with no signs of persistent or recurrent infection, three cases with recurrent infection were cured by drainage of local abscess and debridement, one case died of rupture of the abdominal aortic aneurysm. Conclusion Endovascular grafting combined with antibiotic therapy and careful surveillance program represent an alternative to conventional surgery in mycotic aneurysms caused by Salmonella enterica serotype choleraesuis.

Objective To discuss the diagnosis and surgical treatment of Takayasu arteritis accompanied with aneurysms. Methods The clinical features and the effect of operation types in 14 patients were reviewed.Results All the 14 patients had history of Takayasu arteritis and had steroid therapy before the formation of aneurysms.Among the 14 patients,aortic aneurysms were found in 13(including 9 thoracoabdominal aneurysms),carotid aneurysm with subclavian aneurysm in 1 and multiple aneurysms in 5.All the 14 patients underwent operations ,including replacement of aorta in 11 cases,bypass of aorta in 3 cases,reconstruction of visceral vessels in 8, renal autotransplatation in 1 and replacement of carotid in 1.1case had heart failure and cured ;1 died postoperatively. Eight cases were followed up for 4 months - 18 years,of which, 1 died of heart failure,2 were excellent, 3 of 5 cases with hypertension preoperatively showed normal blood pressure,and the other 2 were controlled by medicines.Conclusions Operation should be performed as early as possible if the aneurysm is found in patients with Takayasu arteritis.The stenosis of renal artery should be resolved during the operation.

Objective To investigate the expression of circulating microRNA (miRNA) of rats with hypobaric hypoxia‐induced pulmonary hypertension (HPH) .Methods Commercial rat miRNA microarray was employed to detect and analyze the circulating miRNA profile in the serum samples of Sprague‐Dawley rats with hypobaric hypoxia‐induced HPH and controls .Furthermore ,differentially expressed candidate circulating miRNAs between HPH and control groups were validated by Real‐time quantitative PCR based on the case‐control study ,and receiver operating characteristic curve (ROC ) analysis was used to test the performance of four differentially expressed circulating miRNAs in discriminating HPH and control groups .Results Compared with those in the control group ,13 upregulated miRNAs and 10 downregulated miRNAs were identified in hypobaric hypoxia‐induced HPH rats by using miRNA microarray . And differentially expressed miR‐451 , miR‐505 , let‐7d and miR‐214 were validated by using RT‐PCR .ROC analysis showed that the area under the curve of miR‐451 ,miR‐505 and let‐7d was 0 .979 ,0 .938 and 0 .993 in discriminating HPH and control groups ,respectively .Conclusion The aberrant expression of circulating miR‐451 ,miR‐505 and let‐7d in serum may be correlated with the pathogenesis of HPH .

ObjectiveTo compare the therapeutic effects of a new surgical endoscopic technique, the transilluminated powered phlebectomy (TriVex System, Smith+Nephew) and pointed phlebectomy in the treatment of varicosis of the great saphenous vein of the lower limbs. Methods Thirty-nine patients (46 limbs) received TriVex operations under spinal, or epidural anesthesia. The powered vein resector and an irrigated illuminator device-a minimally invasive system was used for varicose vein surgery. During the same period, 41 patients (46 limbs) underwent pointed phlebectomy. Results The average postoperative hospital stay was 4.6 days in patients receiving TriVex, and 8.1 days for pointed phlebectomy. Compared with the pointed phlebectomy, the incision of TriVex procedure was shorter and the number less. Conclusion This new surgical device is easy to operate, minimally invasive, efficacious and time saving with satisfactory results.

Objective To compare operative risks of the infrarenal aortic artery reconstruction between abdominal aortic aneurysm (AAA) and aortoiliac occlusive disease (AIOD), and to analyze the causes of the difference. Method Clinical data of 340 cases undergoing aortic artery reconstructions including 222 AAA cases and 118 AIOD cases , were analyzed retrospectively. Results The perioperative mortality was 7.6% and the mortality in AAA group (5.4%) was lower than that in AIOD group (11.9%)(P

Objective To evaluate percutaneous transluminal renal angioplasty ( PTRA) and stenting for the treatment of renal artery stenosis (RAS). Method From Feb 2003 through Jun 2005, 19 consecutive RAS patients received interventional therapy including PTRA and/or stents in 12 cases, aortorenal bypass procedures in 4 cases, nephrectomy in 1, and angiography in 2 cases. Among the 12 PTRA and/or stenting cases, stent was deployed in 10 cases, and 2 patients received PTRA only. Results All patients had hypertension preoperatively ( mean blood pressure 172/98 mmHg). Serum creatinine concentration was greater than 1.5 mg/dL in one patient. There was no perioperative mortality nor major complications. Technical success was achieved in 11 patients (91.7%). During follow-up, mean blood pressure was 156/88 mmHg. Hypertension was improved in 8 patients (66. 7% ). Renal function was stable except one patient with renal insufficiency. Restenosis was found in one patient (8.3%). Conclusion PTRA and/or stent is safe, effective for the treatment of RAS in appropriately selected patients.