Objective To investigate the molecular mechanisms of delayed ischemic preconditioning (IPC) and doxorubicin preconditioning (DPC) to induce ischemic tolerance. Methods The models of sham-operation and orthotopic liver transplantation in the Wistar rats was used. IPC was administered with a 10-min ischemia followed by a 10-min reperfusion. Animals in the DPC group were pretreatd with Doxorubicin (1?mg/kg, iv). The control rats were subjected to saline treatment. The induction of HSP70 and HO-1 protein ( Western blot), the expression of ICAM-1 transcripts (RT-PCR)and ICAM-1 protein (immunohistochemistry), the activities of serum AST, ALT, LDH, and liver myeloperoxidase (MPO) , liver wet-to-dry weight ratios (W/D) were assessed.Results HO-1 expression was maximally induced at 12?h after IPC, and hardly changed until 48?h. A strong induction of HSP70 was detected at about 24 to 72?h after IPC. The levels of HO-1 and HSP70 were obviously elevated at 24?h after IPC or DPC as compared with the control ( P 0.05 ). In the control group, the transcription of ICAM-1 was significantly increased 6?h after reperfusion. Capillary endothelial cells of the livers strongly expressed ICAM-1. Activities of liver MPO were obviously elevated. IPC and DPC could significantly decrease the transcription of ICAM-1 in the livers in concurrence with the expression of ICAM-1 protein as well as the activity of MPO at 6?h after reperfusion ( P

Objective To evaluate the effect of segmental pulmonary veins isolation for atrial fibrillation (AF) and investigate the possible factors that may affect its result. Methods In 120 (105 men; age 50.0?8.6 years) consecutive patients with paroxysmal (n=99) or persistent (n=21) AF, segmental PVs electrical isolation with Lasso mapping catheters was performed. The relationship of the outcome of the initial procedure and factors such as age, sex, type of AF, left atrial diameter, case history, left ventricular ejection fraction and presence of hypertension were analyzed by statistical methods. Results 52 (52.5%) out of the 99 patients with paroxysmal AF and 6 (28.5%) out of the 21 with persistent AF were free of AF after a single ablation procedure. Univariate analysis revealed that left atrial enlargement (P=0.001), persistent AF (P=0.046) and old age (P=0.047) were related to the recurrence of AF after the first procedure. Patients with paroxysmal AF apparently had a better outcome than those with persistent AF after repeat ablation but of no statistical significance (P=0.094). Logistic regression analysis revealed that left atrial enlargement was the only independent risk factor of recurrent AF after the first procedure. Conclusion About 50% of the patients with paroxysmal AF are free of AF after single ablation. Left atrial enlargement is the only independent risk factor of recurrent AF while old age and persistent AF influence the outcome of the first procedure.

OBJECTIVETo observe the reconstruction features of adventitia in senescent rats, and to explore the intervention mechanism of Chinese herbs (CH, extracts from Radix Ginseng, Radix Notoginseng, and Rhizoma Chuanxiong).

METHODSTotally 85 20-month senescent rats were randomly divided into 5 groups according to body weight, i.e., the aging model group, the high dose CH group, the middle dose CH group, the low dose CH group, the Losartan group, 17 in each group. Another 14 2-month old Wistar rats were selected as a young group. Extracts of CH at the daily dose of 1493. 4, 746. 7, and 373. 4 mg/kg were administered to rats in the 3 CH groups respectively by gastrogavage. Losartan suspension at the daily dose of 10 mg/kg was administered to rats in the Losartan group by gastrogavage. Equal volume of distilled water was administered to rats in the aging model group and the young group. All medication was performed once daily. After 15-week intervention, morphological changes of thoracic aorta were observed by HE staining. The types, distribution, and contents of vessel wall collagens were determined using picric acid picrosirius red staining. The plasma renin activity (PRA) , the concentration of rennin angiotensin II (Ang II), and the content of Ang II in adventitia were detected by radioimmunoassay. The content of hydroxyproline ( Hyp) was detected by biochemical analysis. mRNA contents and protein expressions of angiotensin II receptor 1 (AT1R) and angiotensin II receptor 2 (AT2R) were detected by real-time PCR (RT-PCR) and Western blot.

RESULTSCompared with the young group, thickened adventitia, increased adventitia thickness/caliber, accumulated collagen fiber, increased area of type I collagen, decreased area of type III collagen, decreased type III/I collagen area ratio (P <0. 05), decreased plasma PRA and Ang II (P < 0.01, P < 0.05), increased contents of Ang II and Hyp in adventitia, down-regulated mRNA and protein expressions of AT1R, and up-regulated mRNA and protein expression of AT2R could be seen in the aging model group (P < 0.05). Compared with the aging model group, morphological changes could be improved in the 3 CH groups. Adventitia thickness/caliber was reduced in middle and high dose CH groups, as well as the Losartan group. The area of type I collagen was reduced and the area of type III collagen was enlarged, type III/I collagen area ratio obviously increased, contents of adventitia Hyp was obviously lowered in the high dose CH groups and the Losartan group (P < 0.05, P < 0.01). Ang II levels in adventitia decreased in middle and high dose CH groups and the Losartan group (P < 0.05, P < 0.01). There was no statistical difference in PAR among all groups (P > 0.05). Compared with the aging model group, mRNA expression of AT1R all increased in each treatment group (P < 0.01); mRNA expression of AT2R also increased in middle and high dose CH groups (P < 0.05). Protein expression of AT1R increased in the high dose CH group and the Losartan group (P < 0.01, P < 0.05); protein expression of AT2R also increased in middle and high dose CH groups (P < 0.05).

CONCLUSIONSAdventitia remodeling occurred in aged rats, manifested as thickened adventitia and accumulated collagens, disordered ratios of collagen I and III. Its mechanism might be possibly associated with aactivation of renin-angiotensin system (RAS). Extracts from Radix Ginseng, Radix Notoginseng, and Rhizoma Chuanxiong could improve adventitial remodeling possibly by interfering multi-targets, such as Ang II and AT1R, thereby delaying vascular aging.

Adventitia ; drug effects ; Aging ; Angiotensin II ; Animals ; Aorta, Thoracic ; Drugs, Chinese Herbal ; pharmacology ; Losartan ; Panax ; Plant Roots ; RNA, Messenger ; Rats ; Rats, Wistar ; Renin-Angiotensin System ; Rhizome

Objective To investigate the effect of posterior pedicle screw reduction and fixation,decompressive laminectomy and massive autogenous bone grafting using bone particles harvested from resected vertebral body in treatment of lumbar spondylolisthesis.Methods Fifty-six cases of lumbar spondylolisthesis treated from June 2005 and June 2006 were reviewed retrospectively.According to Meyerding classification,35 cases were classified as grade Ⅰslippage and 21 cases as grade Ⅱ slippage.There were 19 spondylolisthesis at L4/5 and 37 at L5-S1.After posterior pedicle screw reduction and fixation,decompressive laminectomy and massive autologous bone grafting using particles of resected vertebral body,surgical outcome was analyzed.Results All cases achieved bone fusion without evidence of nail breakage or nerve injury.According to Macrab criteria,the results were excellent in 53 cases and good in three.Moreover,both the full reduction rate and interbody fusion rate were 100％.Conclusion Posterior pedicle screw reduction and fixation,decompressive laminectomy plus massive autogenous bone grafting is one of the ideal treatments for lumbar spondylolisthesis,for it achieves satisfactory fixation,decompression,reduction and fusion.

Objective To investigate effects of dynamic hip screw (DHS) fixation assisted with blocking screws in treatment of intertrochanteric fracture.Methods A total of 150 patients with intertrochanteric fracture were selected as the combined treatment group,of which the patients managed by DHS intemal fixation were followed by the parallel placement of a blocking screw closely beneath the main screw for stability with its end rested on the plate.Another 87 patients managed by DHS fixation alone were determined as the control group.The surgical outcomes of the two groups were analyzed and compared.Results Good fixation without external displacement of femoral neck and cut-out of the main screw in femoral head was achieved in the combined treatment group.Also,fracture nonunion or death did not exist in the combined group.The patients in combined treatment group could take care of themselves after operation in the absence of severe pain and functional disturbance,with higher excellence rate (98.7％)than that in control group (P ＜ 0.01).Whereas,the operation failure rate was significantly lower in combined treatment group than in control group (P ＜ 0.05).Conclusion DHS fixation assisted with blocking screws is an ideal treatment of incomplete intertrochanteric fracture in medial wall of calcar femorale for it can achieve reliable fixation and definite curative effect,favor fracture healing,early functional exercise and low incidence of postoperative complications.

Objective To discuss the clinical effects of treatment of femoral intertrochanteric fracture by DHS internal fixation. Methods 42 cases with femoral intertrochanteric fracture were treated by DHS internal fixation. According to AO classification, there were 16 cases of type A1,14 A2,and 12 A3. Results 36 patients were followed up for 6 to 18 months, with an average of 10 months. Their results were satisfactory. Conclusion Treatment of femoral intertrochanteric fractures with DHS internal fixation is an effective method.

Objective To improve the diagnosis and treatment of testicular masses associated with congenital adrenal hyperplasia(CAH).Methods A 25-year-old man presented with bilateral testicular nodules.Physical examination revealed palpable multiple nodules in the bilateral testes and epididymides as well as enlarged and hard right testis with uneven surface.Biochemical examination showed testosterone(T) of 18.7 nmol/L,17?-(OH)P＞20.0 ng/ml,positive results of rapid ACTH stimulation test and dexametha- sone suppression test.B-ultrasound demonstrated diffuse testicular lesions with nodules in parts of the bilater- al testes.Bilateral testicular nodules were biopsied,and pathological diagnosis was interstitial cell hyperplasi- a.Positive staining for?-inhibin was observed immunohistochemically.The clinical characteristics of testicular masses associated with CAH were reviewed in combination with the literature.Results Based on medical history,imaging,laboratory and pathologic examinations,the patient was diagnosed with testicular masses as- sociated with CAH.He received oral cortisol at dose of 40 mg daily for 2 weeks,and then at dose of 30 mg daily as maintenance therapy.After treatment of 8 months,B-ultrasound showed complete regression of the testicular tumors.Follow-up of 24 months showed no recurrence of the tumor.Conclusions For patient with bilateral testicular masses,endocrinological evaluation and clinical history taking are indicated to exclude testicular interstitial cell hyperplasia associated with CAH.By oral steroid replacement therapy,hormone-sen- sitive testicular masses can regress.

Objective:To summarize the CT signs and characteristics of bone-tumor.Methods:The CT and plain film signs of 71 cases of malignant bone-tumor and 19 cases of benign bone-tumor were analyzed.Results:The basic signs of bone-tumor were bone destruction, tumor bone formation,periosteal reaction,and soft tissue mass.Both benign and malignant bone-tumor had its characters of CT signs.Enhanced CT scans were advantageous in showing the tumor neighboring vessels.Conclusion:Our understanding is expanded and deepened for the signs of bone-tumor by CT scanning.This method provides much more accurate and comprehensive imaging informations than plain film.

ObjectiveTo evaluate the effectiveness of correction of posttraumatic flexion contracture of knee(FCK) using Ilizarov technique.MethodsSix male patients with posttraumatic FCK,aging from 9 to 43 years(mean,24.5 years),treated by using Ilizarov technique from January 2006 to December 2010,were retrospectively analyzed.The preoperative flexion deformity of knee ranged from 35° to 85° (mean,47.6°),and the range of motion ranged from 0° to 70° (mean,15.8°).Among them,five patients had old fracture of knee joint combined with equinus foot deformity (deformity ranging from 25° to 37°,with an average of 31.8°); one patient had femoral supracondylar fracture.We used circular external fixator to correct the FCK and equinus foot deformity gradually,the knee arthrodesis operation was performed in 4 patients because of the damaged hone structure and poor soft tissue condition.ResultsAll patients were followed up for 12-22 months(mean,18 months).The flexion of knee joint was recoverd from preoperative 47.67°±18.63° to postoperative 9.33°±3.50°.Plantar flexion of ankle joint in five equinus foot deformity was recovered from preoperative 31.80°±4.65° to postoperative 3.00°±4.47°.The kuee joint was arthrodesised successfully in 4 patients and the other 2 patients got 30° and 75° ROM.All the patients can walk with a cane,and satisfied with the result of treatment.Pin-site infection was found in 4 patients and was controlled within two weeks.ConclusionIlizarov technique is an effective treatment method for posttraumatic FCK.Knee arthrodesis should be performed when patients had damaged bone structure and poor soft tissue condition.

Objective To study the application of intraoperative drug administration in simultaneous pancreas-kidney transplantation(SPK), in order to achieve favorable postoperative results. Methods In the 19 cases of SPK,we primarily administered albumin 1.5~2.0g/kg to increase blood volume. Intraoperative electrocyte fluid dosage was 30~50mL/kg. Isoptin, 5mg/12h and prostaglandin E1(PGE1) 100?g/12h was given to lessen preservation injury and somatostatin(3mg/12h) to inhibit exocrine secretion of the transplanted pancreas. Results After reperfusion,the 19 transplanted pancreas grafts secreted amylase averaging 20 800U/L,and the transplanted kidneys produced urine,through the ureters,in 2~10min.In the 19cases,exogeneous insulin was withdrawn within 1.5h~9d and kidney function returned to normal within 2~4d. Conclusions In the SPK recipients, the rational use of albumin, vasodilators and somatostatin plays an important role in obtaining better function of transplanted pancreas and kidney.