Objective To review systemically the safety of endoscopic vessel harvesting ( EVH ) in coronary artery bypass grafting (CABG). Methods By searching documentations in the Cochrane Library , Pubmed, Medline,EMbase, CBM, CNKI, Wanfang database , and Weipu database , with no limits for language , a random-controlled meta-analysis was assembled for evaluating the safety of EVH of great saphenous veins in CABG .The retrieval deadline of these databases was September 2013.Two evaluators were in charge of selecting , extracting , and assessing the quality of methodology in all these articles according to extract criterion independently.The RevMan 5.2 was used for meta-analyse. Results The whole test included 12 RCTs and 1510 patients, comprising of 857 patients with EVH and 653 patients with traditional harvesting .As compared with traditional group , the EVH group showed lower rate of postoperative incision infection [OR=0.24, 95%CI:0.16-0.36, P<0.0001], less postoperative pain [OR=-1.06, 95%CI:-1.26--0.86, P<0.0001], and less postoperative complications [OR=0.28, 95% CI:0.19-0.42, P<0.0001].There were no significant differences between the two groups in hospital stay [WMD=0.17, 95%CI:-0.22-0.56, P=0.40] and mortality [OR=0.88, 95% CI:0.30 -2.64, P=0.82]. Conclusion EVH factually reduces trauma in CABG, postoperative infection rate , postoperative pain , postoperative complications , and hospital stay ,being applicable for high risk patients .

Objective: To systemically evaluate the efifcacy and safety of coronary artery bypass grafting (CABG) without stopping pre-operative aspirin administration for anti-platelet therapy in relevant patients. Methods: The computer searching including Cochrane Library (Issue 2, 2014), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP was conducted to collect the randomized controlled trial (RCT) for CABG without stopping pre-operative aspirin administration from the data base establishment until 2014-07. There were 2 reviewers identiifed the literatures independently according to inclusion, exclusion criteria, and extracted the information, evaluated the quality of assessment methods, then meta-analysis was performed by RevMan 5.2 software. Results: A total of 8 RCT studies including 1945 patients were enrolled. The meta analysis showed that compared with stopping pre-operative aspirin administration, the patients without stopping pre-operative aspirin had obviously increased post-operative bleeding drainage as MD=235.97,P=0.01, re-operation for bleeding as OR=2.4,P=0.0005 and fresh frozen plasma transfusion requirement as MD=0.79,P<0.0001. While the packed red blood cell (PRBC) transfusion requirement as MD=0.66, P=0.05, platelet transfusion requirement as MD=0.99,P=0.25, the incidence rate of post-operative myocardial infarction as OR=1.03,P=0.90 and post-operative mortality (OR=1.24,P=0.56) were similar between two conditions. Conclusion: CABG without stopping pre-operative aspirin administration may increase the post-operative bleeding,transfusion and re-operation for bleeding; low dose aspirin administration before CABG needs further investigation to solve the above problems in clinical practice.

Background The primary pathologic mechanism of posterior capsular opacification (PCO) is proliferation,migration and epithelial-mesenchymal transformation of residuary lens epithelial cells (LECs) following cataract surgery.Matrix metalloproteinases (MMPs) play a role during the migration of LECs.Researches showed that GM6001,a broad inhibitor of MMPs,can arrest the migration of LECs,but as specific inhibitors of MMPs,the efficacy and safety of MMP-2/9 inhibitor Ⅰ and Ⅱ on LECs migration remain unclear.Objective This study was to determine and compare the inhibitory efficacy among GM6001,MMP-2/9 inhibitor Ⅰ and Ⅱ on human LECs and search the clinical medication to prevent PCO.Methods Human LECs were cultured and passaged in vitro,and the cells of 3-4 generation were incubated in 6-well plates.Then the cells of 70％ confluent monolayer were cultured in DMEM without fetal bovine serum for 12 hours.GM6001,MMP-2/9 inhibitor Ⅰ and Ⅱ at different concentrations (0.25,0.50,1.00,2.00,4.00,8.00,16.00,32.00,64.00,128.00 μmol/L) were added into the culture medium for 24 hours separately,and regularly cultured cells served as the control group.A bare area was made by a 200 μl sterile spear on the cell layer,and the migrated distance and inhibitory rate were calculated.The second or third generation of cells were incubated in 96-well plates at a density of 5×105/ml (200 μl/well).GM6001 (128.00 μmol/L),MMP-2/9 inhibitor Ⅰ (64.00 μmol/L) and Ⅱ (32.00 μmol/L) were added into the culture medium for 24 hours,and the cell viability was assayed by using MTT assay.Results Cultured cells grew well with irregular arrangement and presented the polygon in shape.The migrated distance was gradually reduced as the increase of concentrations of GM6001,MMP-2/9 inhibitor Ⅰ and Ⅱ,showing significant differences among the various concentration groups (GM6001:F=248.647,P＜0.05;MMP-2/9 inhibitor Ⅰ:F=357.125,P＜0.05;MP2/9 inhibitor Ⅱ:F=396.374,P＜ 0.05).The cell migrated distance in the control group was set to 1,the relative migrated distances were 0.478 ± 0.091,0.294±0.088 and 0.191 ±0.081 in the GM6001 group,MMP-2/9 inhibitor Ⅰ group and MMP-2/9 inhibitor Ⅱ group at the concentrations of 32.00 μmol/L,respectively,showing a significant difference among the groups (F =116.031,P＜0.01),and cell migrated distance was obviously shorter in the MMP-2/9 inhibitor Ⅱ group than that in the GM6001 group or MMP-2/9 inhibitor Ⅰ group (all at P＜0.01).The A values were 0.607±0.016,0.567±0.015,0.583±0.010 and 0.595 ±0.0138 in the control group,GM6001 group (128.00 μmol/L),MMP-2/9 inhibitor Ⅰ group (64.00 μmol/L) and MMP-2/9 inhibitor Ⅱ group (32.00 μmol/L),respectively,without significant difference among the groups (F=1.403,P＞0.05).Conclusions GM6001,MMP-2/9 inhibitor Ⅰ and Ⅱ reduce the mobility of human LECs effectively but do not affect the viability of the cells in vitro.MMP-2/9 inhibitor Ⅱ appears to be most dominant in inhibiting migration of human LECs.

To study the role of the reversion-inducing-cysteine-rich protein with Kazal motifs (RECK) gene and matrix metalloproteinase-2 (MMP-2) in the regulation of trophoblast invasion of early pregnancy. Immunohistochemistry, Western blot and gelatin zymography were used to detect the RECK protein expression localization, expression level and MMP-2 activation level in the placental tissues harvested from 52 normal pregnant women (27 in the early pregnancy, 25 in the term pregnancy). Immunohistochemistry showed that RECK expression was found both in villous tissues of early pregnancy group and term pregnancy group and was mainly observed in cell membrane and cytoplasm of cytotrophoblasts and syneytiotrophoblasts. RECK expression increased with gestational time. RECK expression of early pregnancy group was significantly lower than that of term pregnancy group (P<0.05). RECK expression was significantly lower in cellular column (CC) with invasion ability. Western blot showed that the RECK protein expression in early pregnancy group was significantly lower than that in term pregnancy (P<0.05). The optical density values of RECK protein expression in early pregnancy group and term pregnancy group were 1.35-0.14 and 2.68+/-0.26, respectively, while MMP-2 activation ratio was contrary to RECK protein expression and decreased with the gestation time (P<0.01). The MMP-2 activation ratios of early pregnancy group and term pregnancy group were 0.46 +/- 0.05 and 0.10+/-0.02, respectively. The expression of the tumor inhibitory gene RECK was positively related with the invasion ability of trophoblasts, while the invasion gene MMP-2 was negatively related with the ability. The interaction between RECK and MMP-2 may play an important role in the regulation of the trophoblast invasion in early pregnancy.

Objective To analyze the hypothalamic-pituitary-adrenal axis function in type 2 diabetes mellitus(T2DM) patients combined with depression with different courses.Methods Forty T2DM without depression patients (T2DM without depression group) and 42 T2DM combined with depression patients (T2DM combined with depression group) were divided into 3 groups according to the courses:＜ 5years,5-15 years,＞ 15 years.Thirty healthy person were selected as control group.The levels of serum adrenocorticotropic hormone (ACTH),cortisol (Cor),fasting blood glucose (FPG),glycosylated hemoglobin (HbA1c),24 h urinary-free cortisol (UFC) were determined at 8:00 Am.Results The levels of serum ACTH,24 h UFC in T2DM without depression group were higher than those in control group [(241.7 ±132.6) pg/L vs.(174.1 ± 108.2) pg/L and (96.67 ± 15.92) μg vs.(76.04 ±24.60) μg],and there were significant differences (P ＜ 0.05 or ＜ 0.01).There were no significant differences in the levels of serum ACTH,Cor,24 h UFC among ＜ 5 years,5-15 years,＞ 15 years in T2DM without depression group (P＞0.05).The levels of serum Cor,24 h UFC in T2DM combined with depression group were higher than those in T2DM without depression group and control group,and there were significant differences (P ＜ 0.01),but compared with those in T2DM without depression group with the same courses,only ACTH was different in ＜5 years (P ＜ 0.01),Cor,24 h UFC was different in ＞ 15 years (P ＜ 0.01).There was significant difference in the level of serum ACTH between ＜ 5 years and 5-15 years,＞ 15 years in T2DM combined with depression group (P ＜ 0.01),Cor had no difference among different courses (P ＞ 0.05),24 h UFC had difference between ＞ 15 years and ＜ 5 years,5-15 years (P＜ 0.01 or ＜ 0.05).In T2DM without depression group,the level of serum Cor was positively correlated with FPG (P ＜ 0.01),the level of serum ACTH was positively correlated with FPG (P ＜0.05).In T2DM combined with depression group,the level of serum Cor was positively correlated with FPG,HbA1c (P ＜ 0.01),the level of serum ACTH was no relationship with others,the level of serum 24 h UFC was positively correlated with FPG,HbA1c (P＜ 0.01).Conclusion With the prolonged courses of diabetes,the function of hypothalamic-pituitary-adrenal axis gets worse in T2DM patients combined with depression.

Valve replacement is the primary means of treatment of valvular disease. With the further research of artificial valve, Prosthesis-patient mismatch is becoming a hot research hotspot. This paper reviews research status of Prosthesis-patient mismatch.

Objective:To deeply understand the real experience of family members of patients in the neurosurgery intensive care unit during the period of accompanying them, and to provide reference for managers to formulate nursing countermeasures to improve the coping ability of family members.Methods:Descriptive phenomenological research method in qualitative research was adopted to conduct in-depth interviews with family members of 12 patients admitted to a neurosurgery intensive care unit in Shanghai, manage the interview data with Nvivo11 software, and use Colaizzi's seven-step analysis method to summarize and analyze the topic.Results:There were four themes: adhere to and do not give up, adhere to was due to the trust and affirmation of the medical care, do not give up was because it was difficult to give up blood kinship, adhere to the hope of life because of patients; timing change of emotional experience, first aid period: helpless to rescue and expecting the condition to stabilize, complication peak: understanding the characteristics of the disease and paying attention to the treatment progress, stable period: uncertain prognosis and desire for emotional companionship.The powerlessness of the future; learn to self psychological adjustment.Conclusions:The family members of patients with severe neurological diseases have both negative experience and positive feelings, and the accompanying experience and needs at different stages of the disease are changing dynamically. According to the cognition and needs of the family members, exploring and developing palliative medicine, tapping the potential of the family members from a positive perspective and improving coping ability are one of the ways to maintain the stable mental health of the family members.

Objective To investigate and evaluate the changes of PYK2 expression in hippocampal neurons and microglial cells in Kainate acid-induced status epilepticus. Methods Kainate acid-induced status epilepticus was established in rats, and by using immunostaining, changes of PYK2 expression in hippocampal neurons and microglial cells was investigated. Results Expression of PYK2 in hippocampal pyramidal neurons was markedly decreased after kainate acid-induced status epilepticus. However, 24h after the epileptic onset, a pronounced up-regulation of PYK2 and phosphor-PYK2 immunoreactivities were evident in amoeboid microglial cells. The upregulation of PYK2 and phosphor-PYK2 was in accordance with the morphological changes of the activated microglial cells. Conclusion PYK2 was activated in microglial cells after seizure. Furthermore, the activation of PYK2 in microglial cells after seizure might be related to the morphological and behavioral changes of microglial cells after activation.

Objective To investigate and evaluate the changes of phospho PYK2 and phospho p38MAPK expression in neurons after focal cerebral ischemia. Methods Focal ischemia reperfusion model was established in rats, and by using immunostaining, the changes of phospho PYK2 and phospho p38MAPK expression in neurons was observed. Results Faint phospho PYK2 and phospho p38MAPK immunoreactivity were revealed in normal cortical neurons. Fifteen minutes after the ischemia onset, a pronounced upregulation of phospho PYK2 and phospho p38MAPK immunoreactivities were evident in these ischemia attacked neurons. The immunoreactivities of phospho PYK2 and phospho p38MAPK reached its peak at 30min after ischemia, and decreased 60min after ischemia. Conclusion Cerebral ischemia was able to induce neuronal PYK2 phosphorylation. The activation of PYK2 might link ischemia attack to the p38MAPK signaling pathway to initiate the neuronal response to the stress stimuli

Objective To explore the relationship between smoking and pain intensity in heroin-dependent patients (HDPs) receiving methadone maintenance treatment (MMT).Methods A total of 603 HDPs from MMT outpatients completed a socio-demographic and clinical characteristics questionnaire,a smoking questionnaire,Heaviness of Smoking Index,and Zung's Self-rating Depression Scale.Five-point Verbal Rating Scale was used to assess pain intensity.Results After adjustment for the confounding effects of socio-demographics,clinical characteristics,and depressive symptoms in the analysis of covariance,smokers had significantly higher pain intensity score compared with non-smokers (F=1 1.836,P=0.002).Multiple comparisons showed that the pain intensity level of patients with moderate-to-severe nicotine dependence was the highest,patients with mild nicotine dependence took the second place,and patients with no nicotine dependence was the lowest [(3.11±1.04) vs.(2.67±1.13) vs.(2.47± 1.15),all P＜0.05].Conclusion Smoking is significantly associated with pain in HDPs receiving MMT.The more severe the nicotine dependence that a HDP has,the intense the pain he/she has.