Objective To investigate possible changes of lipoprotein(a) [Lp(a)] and oxidized Lp (a) [ox-Lp(a) ] levels after PCI and it mechanisms. Methods Bloods were selected from 75 patients with ACS undergoing PCI, and at 24 hours, 2 and 3 days, and 6 months pre-and post-PCI treatment, and from 29 control patients pre-and post-coronary angiography without undergoing PCI. The levels of Lp(a) , ox-Lp(a) , Lp(a) immune complexes (IC) and its autoantibody were determined by ELISA. The extents of CAD were determined by coronary angiography. The differences of variants pre-and post-operations were analyzed by paired samples t test. The differences of levels of Lp(a) and ox-Lp(a) among time points after PCI were analyzed by ANOVA. Correlations between Lp(a) and ox-Lp(a) , and between angiographic variables and Lp(a), ox-Lp(a) levels were calculated. Results Compared to pre-PCI, Lp(a) [233.10 (152.86-328.79) mg/L vs 202.05 (106.15-271.42) mg/L, t=6. 81, P<0.01], ox-Lp(a) [19.05 (10.98-31.80) mg/L vs 10. 51 (4.98-17.97) μg/ml, t = 13. 22,P <0. 01] and Lp(a)-IC [2.72 (1.604.91) AU vs 2. 11 (1.04-3. 97) AU, t = 3. 34, P < 0. 01 ] levels significantly increased immediately in post-PCI, while its antoantibody levels significantly decreased (A = 0. 81 ± 0. 33 vs A = 0. 72 ± 0. 28, t = 5.58, P < 0. 01). Strong correlations were noted between levels of ox-Lp( a) and Lp( a) both in pre-PCI (r =0. 66, P <0.01) and post-PCI (r = 0. 62, P <0. 01). PCI resulted in rapidrise of Lp(a) and ox-Lp(a) levels and then decreased quickly in 24 hours, returned to baseline in 2-3 days. The changes of Lp(a) and ox-Lp(a) levels in pre-and post-PCI were positively related with severity of ACS. In contrast, in the angiography-only control group, no significant changes were noted in Lp(a) , ox-Lp(a) , Lp(a)-IC and Lp(a) autoantibodies levels between the pre-and post-angiography samples. Conclusion PCI results in acute plasma acute increases of levels of Lp(a) and ox-Lp(a) ,and the changes are related with lesion severity of the coronary artery.

Objective To investigate the clinical value of hand-sewn ileal pouch anal anastomosis (HIPAA) for the treatment of ulcerative colitis.Methods The clinical data of 191 patients with ulcerative colitis who were admitted to the General Hospital of Tianjin Medical University from January 1989 to December 2013 were retrospectively analyzed.All the patients received proctocolectomy and open or laparoscopic HIPAA.Patients were followed up by questionnaire at postoperative month 3 and 12.The function of pouch was evaluated according to the defecation frequency per 24 hours and per night,Bristol scale stool form and Kirwan classification.The quality of life was assessed according to the Cleveland global quality of life (CGQL).Patients were followed up till April 2014.The independent samples were compared by t test,and data from multiple groups were compared by analysis of variance,pairwise comparison was done by LSD-t test,and the count data were analyzed using the chi-square test.Results Of the 191 patients,180 received open surgery and 11 received laparoscopic surgery.Nine patients were treated by one-stage surgery,175 by two-stage surgery and 7 by three-stage surgery.The pouches of 181 patients were J shape,9 were H shape and 1 was W shape.No patient died perioperatively.Eight patients had abdominal infection and 7 had incisional infection at early period after the operation,and they were cured by antibiotics.Four patients had pouch anastomotic bleeding and 4 had anastomotic leakage at postoperative week 1-2,and they were cured by local hemostasis or titanium clipping.Six patients had high intestinal obstruction,and they were alleviated by symptomatic treatment.Eight patients had inflammation of pouch,and they were alleviated by diet adjustment or antibiotics treatment.Two patients had sexual dysfunction.All the patients were followed up for 1-25 years.The function of the pouch was improved gradually.At postoperative month 12,the defecation frequencies were (3.7 ± 1.4)/24 hours and (1.3 ±0.5)/night,and the number of patients with type Ⅳ (Bristol classification),type Ⅴ,type Ⅵ and in grade Ⅰ (Kirwan classification),grade Ⅱ,grade Ⅲ were 107,76,8 and 177,8,6,respectively,which were significantly improved when compared with (6.5 ±2.8)/24 hours,(2.9 ± 1.5)/night,86,89,16 and 160,19,12 at postoperative month 3 (t =12.36,3.98,x2=7.76,29.27,P＜ 0.05).The CGQL indexes before operation and at postoperative month 3 and 12 were 0.37 ±0.19,0.67 ±0.16 and 0.82 ±0.13,respectively,with significant differences (F =6.011,P ＜0.05).There were significant differences between the CGQL indexes before operation and at postoperative 12 and 3 months (t =16.69,10.06,P ＜ 0.05).A significant difference was also observed between the CGQL indexes before operation and at postoperative 12 months (t =27.01,P ＜ 0.05).Conclusions HIPAA is suitable for the surgical treatment of ulcerative colitis.The function of the pouch is good and the quality of life is improved.

Objective To investigate the short-term clinical efficacy and complication of esophageal cancer patients with two-field lymph node dissection by thoracolaparoscopic esophagectomy surgery and open surgery. Methods One hundred and fifty esophageal cancer patients with two-field lymph node dissection were selected, and they were divided into control group (using open surgery, 75 cases) and observation group (using thoracolaparoscopic esophagectomy surgery, 75 cases) by random digits table method. The operation time, bleeding amount, hospital staying time, number of lymph node dissection, reoperation rate, intensive care unit (ICU) transferring rate and postoperative complication were compared. Results There was no statistical difference in operation time between 2 groups ( P>0.05). The bleeding amount and hospital staying time in observation group were significantly lower than those in control group: (210.33 ± 30.71) ml vs. (254.59±35.28) ml and (8.45±1.52) d vs. (11.61±2.08) d, there were statistical differences (P<0.05). The number of chest lymph node dissection in observation group were significantly higher than those in control group:(17.20±4.06) pieces vs. (10.44±2.65) pieces, and there was statistical difference (P<0.05). There were no statistical differences in reoperation rate and ICU transferring rate between 2 groups ( P>0.05). There were no statistical differences in incidences of hoarseness and anastomotic stenosis between 2 groups ( P>0.05). The incidences of pulmonary infection and arrhythmia in observation group were significantly lower than those in control group:17.33%(13/75) vs. 30.67%(23/75) and 2.67%(2/75) vs. 14.67%(11/75), and there were statistical differences (P<0.05). Conclusion Compared with open surgery, thoracolaparoscopic esophagectomy surgery with two-field lymph node dissection for esophageal cancer patients can effectively reduce the degree of operative trauma, accelerate postoperative rehabilitation process, improve the effects of lymph node dissection, and reduce postoperative complication risk.

By analyzing repeated judicial expertise cases of illegal practice,we find it a serious threat to patients' health and safety,and more deep-seated reasons for illegal medical practice of medicine are discovered as follows.Investigators and expertise staff have to face legal,ethical,social and other factors when judging the relationship between illegal medical practice and adverse consequences(patient injury or death),which are quite worth exploration in depth to clear up the complicated relationships.

Objective:To study the influence of neurogenic anorectum induced by myelodysplasia on function of anorectum.Methods:Twenty-five patients with myelodysplasia were evaluated by anorectal manometry.The function of anal sphincter was evaluated by resting pressure,contractive pressure and the length of high pressure;The sensation of rectum was evaluated by rectal maximum volume threshold;The function of defecation reflex was evaluated by rectoanal inhibitory reflex.Results:Anal resting pressure in the children with neurogenic anorectum induced by myelodysplasia( 25.8?3.4)mmHg was lower than that in normal children(66.7?24)mmHg.The maximum contractive pressure of anus in patients (86.6?20.1)mmHg was lower than that in normal children(129.0?18.8)mmHg.The length of high pressure in patients (17.5?4.5)mm was lower than that in normal children(23.6?4.6)mm.The rectal volume at sensory threshold in patients(62.1?8.5)ml was higher than that in normal children(36.0?12.6)ml.Rectal maximum volume threshold in patients(141.4?22.6)ml was higher than that in normal children (109.5?12.2)ml.Rectoanal inhibitory reflex was identified in both patients and normal children.Conclusions:Anorectal manometry may provide objective assessment of the neurogenic damage of anorectum in myelodysplasia including the damage of sphincter and the decrease of the rectal sensation. Rectoanal inhibitory reflex was identified in both patients and normal children. The major objective of anorectal treatment for patients with myelodysplasia was to strengthen the function of external sphincter, internal sphincter and pelvis floor muscle and to repair the sensation of rectum.

BACKGROUND:An effective freezing-thawing technique is crucial for the clinical application of human umbilical cord mesenchymal stem cells(UC-MSCs).OBJECTIVE:To investigate biological characteristics of UC-MSCs after cryopreservation.METHODS:UC-MSCs were isolated from human umbilical cord and frozen in liquid nitrogen.The survival rate and the suppressive effect of γ-interferon(IFN-γ)of cryopreserved-thawed and fresh human UC-MSCs were compared.Furthermore,the multiple potentials and phenotype of UC-MSCs were estimated after cryopreservation.RESULTS AND CONCLUSION:There was no significant difference between cryopreserved-thawed and fresh human UC-MSCs on the survival rate and the suppressive effect of IFN-γ of peripheral blood mononuclear cells(PBMCs).After cryopreservation,human UC-MSCs had the potential differentiation and the phenotype of mesenchymal stem cells.

BACKGROUND:Cobalt chloride (CoCl2) may promote the proliferation of human umbilical cord-derived mesenchymal stem cels (hUC-MSCs) in a time- and concentration-dependent manner, and meanwhile, CoCl2 can regulate the expression of genes and proteins in hUC-MSCs. OBJECTIVE:To explore the effects of CoCl2 induced-hypoxia on the proliferation of hUC-MSCs and gene and protein expressions in hUC-MSCs, thereby establishing an effective method for MSCs culture and amplificationin vitro. METHODS: hUC-MSCs were extracted using tissue explant method. Under hypoxia conditions induced by CoCl2 (0, 100, 150, 200, 250 μmol/L) for different periods (0, 1, 2, 3, 4 days), flow cytometry was used to identify cel surface-associated antigens; cel counting kit-8 was used to detect cel proliferation; RT-PCR was used to determine levels of hypoxia inducible factor-1α, inducible nitric oxide synthase, stromal cel-derived factor-1, interleukin-6, transforming growth factor-β mRNA; western blot assay was used to detect protein expression of hypoxia inducible factor-1α. RESULTS AND CONCLUSION:The cels were positive for CD29, CD73, CD90, CD105, while negative for CD31, CD14, CD34, CD45, CD11b, HLA-DR. Moreover, the antigen expression was not affected by CoCl2 induced-hypoxia. CoCl2 induced-chemical hypoxia could promote the proliferation of hUC-MSCs in a time- and concentration-dependent manner. RT-PCR results showed thatunder hypoxia, hypoxia inducible factor 1α, inducible nitric oxide synthase and stromal cel-derived factor-1 mRNA expressions were significantly up-regulated, but interleukin-6 and transforming growth factor-β mRNA expressions were down-regulated significantly (P < 0.05). Additionaly, the protein expression of hypoxia inducible factor 1α was increased under hypoxia conditions. These findings indicate that CoCl2 induced-hypoxia environment may promote the proliferation of hUC-MSCs and the optimal concentration of CoCl2 is 200μmol/L. However, a higher concentration of CoCl2 (≥ 250μmol/L) inhibits the proliferation of hUC-MSCs, and the mechanism may be related to the increase of hypoxia inducible factor-1α at protein and mRNA levels.

Objective To investigate the treatment and prognosis of metastatic ovarian carcinoma from gastrointestinal tract. Methods The clinical data of 110 patients with metastatic ovarian carcinoma were reviewed. Results The median age of 110 patients was 45 years old.Metastatic ovarian carcinomas were from stomach (74.5%),and colon and rectum (25.5%).The median overall survival time of 110 patients was 16.3 months,and the median progression-free survival time of 110 patients was 8.2 months.Survival rates of 1-,3-and 5-year were 68.4% 、15.4% and 2.5%,respectively.In univariate survival analysis,different origins(P ＜ 0.01),extent of recurrent disease (P ＜ 0.01),cytoreductive surgery (P ＜0.01),intraperitoneal chemotherapy (P ＜ 0.05) and pathologic type of metastatic ovarian carcinoma (P ＜0.05) were correlated with the prognosis.Age,menstrual history,ascites,and chemotherapy have less effect on prognosis (P ＞ 0.05).In multivariable analysis,different origins (P ＜ 0.01),extent of recurrent disease(P ＜ 0.05) and cytoreductive surgery (P ＜ 0.01) were confirmed to be independent factor. Conclusion Patients with metastatic ovarian carcinomas have poor prognosis.Optimal cytoreduction significantly prolongs overall survival in patients with metastatic ovarian carcinoma from gastrointestinal tract.

Anti-Arrhythmia Agents ; therapeutic use ; Cardiomyopathies ; drug therapy ; etiology ; Child, Preschool ; Female ; Humans ; Moricizine ; therapeutic use ; Tachycardia ; complications ; drug therapy ; Treatment Outcome

OBJECTIVETo explore the effects of different acupuncture depths of Lianquan (CV 23) for dysphagia after stroke.

METHODSTwo hundred and fifty-one patients with dysphagia after stroke were randomly divided into a deep acupuncture group (group A, 85 cases) a shallow acupuncture group (group B, 83 cases) and a glossopharyngeum acupuncture group (group C, 83 cases). Based on the conventional treatment, the glossopharyngeum acupuncture which was pricking without needles retained at lingual surface, posterior pharyngeal wall of the affected side, Jinjin (EX-HN 12) and Yuye (EX-HN 13) was used in the three groups. After the glossopharyngeum acupuncture, Lianquan (CV 23) was acupunctured 60-70 mm in the group A and 30-40 mm in the group B. The needles were all retained for 30 min. The treatment was applied once a day for 30 days in the three groups. Water swallowing test evaluation scale was observed before and after treatment, and the efficacy was assessed in the three groups.

RESULTSThe total effective rate was 95.3% (81/85) in the group A, which was better than 85.5% (71/83) in the group B and 83.1% (69/83) in the group C (both P < 0.05). The water swallowing test scores were decreased apparently in the three groups (all P < 0.01), and scores in the group A were the most obvious decline (P < 0.01). The decrease of scores in the group A was more remarkable than those in the group B and the group C after two weeks of treatment (both P < 0.05).

CONCLUSIONAcupuncture at Lianquan (CV 23) can effectively improve the dysphagia after stroke. The acupuncture depth can affect efficacy and the effect of deep acupuncture is better.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Deglutition Disorders ; complications ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stroke ; complications