Objective To evaluate the role of calcium channel in the mechanism of the generation and maintenance of bursting firing of substantia nigra pars compacta (SNc) dopaminergic neurons in rats.Methods Using the patch clamp technique,we observed the firing pattern switching features after adding 10 μmol/L N-methyl-D-aspartic acid (NMDA),compared the changes of whole-calcium current and L-type calcium current with or without NMDA,and analyzed the correlation between the generation of burst firing and L-type calcium channel activation.Results After NMDA treatment,the firing pattern of SNc dopaminergic neurons changed to burst firing,which was compromised by a charastistic high plateau potential and series of action potential on it.The current density of L-type calcium current increased significantly after adding NMDA,which,from (2.86 ±0.26) pA/pF (n =28),significantly increased to (3.75 ± 0.18) pA/pF (n =34 ; t =7.52,P =0.002 8).The high plateau potential was almost abolished with the application of verapamil,a specific antagonist of L-type calcium channel.Consiusion NMDA could induce the firing pattern changed to burst firing in SNc dopaminergic neurons,while L-type calcium channel contributes to the process of generation and maintenance of burst firing.

Objective To investigate the clinical effects of a modified splenocaval shunt combined with pericardial devascularization ( PCDV ) in the treatment of gastroesophageal variceal bleeding. Methods From 1997 to 2007, 168 patients with gastroesophageal variceal bleeding caused by portal hypertension were treated at the People's Hospital of Shaanxi Province. Among all the patients, 90 received a splenocaval shunt + PCDV(combined group) and the remaining 78 received PCDV (PCDV group). Changes in intra- and postoperative hemodynamics of the portal venous system were detected by Doppler color flow imaging, and free portal pressure was measured intraoperatively. All data were analysed using analysis of variance, the paired t test and chi-square test.Results The mortality was 3% (3/90) in the combined group and 5% (4/78) in the PCDV group, with no significant difference between the two groups (x2 = 0.038, P ＞0.05 ). The postoperative rebleeding rate was 6%(5/79) in the combined group, which was significantly lower than 13% (8/60) in the PCDV group (x2 =4.824,P ＜ 0.05 ). The incidence of hepatic encephalopathy was 6% (5/79) in the combined group and 7% (4/60) in the PCDV group, with no significant difference between the two groups ( x2 = 0.072, P ＞ 0.05 ). The 1-, 3-, 5-,and 10-year survival rates were 97% (77/79), 92% (55/60), 80% (16/20) and 60% (3/5) in the combined group, and 97% (58/60), 83% (40/48), 73% (22/30) and 53% (8/15) in the PCDV group, respecitvely,with no significant difference between the two groups ( x2 = 0.731, P ＞ 0.05 ). The intra- and postoperative portal pressures in the combined group were (38.8±4.2) cm H20 ( 1 cm H2O =0. 098 kPa) and (33.1 ± 1.5) cm H2O,with a significant difference ( t = 8. 574, P ＜ 0.05 ). The intra-and postoperative portal pressures in the PCDV group were (38.9±2.5) cm H2O and (34.6±2.6) cm H2O, with a significant difference (t =6. 530, P ＜0.05 ). There was also a significant difference in postoperative portal pressure between the two groups ( t = 2. 859,P ＜ 0.05 ). The intra-and postoperative diameters of the portal vein in the combined group were (1.40 ± 0.41 )cm and ( 1.22 ± 0. 15) cm, respectively, with a significant difference ( t = 2. 608, P ＜ 0.05 ). The intra-and postoperative portal venous flows in the combined group were (1280 ±350) ml/min and (830±360) ml/min, with a significant difference ( t = 5. 668, P ＜ 0. 05 ). The intra-and postoperative diameters of the portal vein in the PCDV group were ( 1.41 ±0.32) cm and ( 1.27 ±0.32) cm, respectively, with no significant difference between the two groups (t = 1. 637, P ＞ 0.05 ). The intra-and postoperative portal venous flows in the combined group were ( 1350 ± 380) ml/min and (980 ± 290) ml/min, with a significant difference ( t = 4. 096, P ＜ 0.05 ). There was no significant difference in postoperative portal venous flow between the two groups ( t = 1.871, P ＞ 0.05 ).Conclusions The modified splenocaval shunt combined with PCDV is safe and effective with a low rate of recurrent rebleeding. The clinical outcome and rational hemodynamic changes show that the combined procedure of splenocaval shunt and PCDV is a good choice for treatment of gastroesophageal variceal bleeding.

Objective To explore the clinical characteristics of portal vein thrombosis(PVT) after splenocaval shunt plus devascularization in treatment of portal hypertension and find Out ways for its prevention.Methods The formation,diagnosis,treatment of PVT and variceal rehemorrhage in 110 patients with portal hypertension who received splenocaval shunt plus devascularization procedures (Combined Group)and 92 patients subjected to pericardial devascularization operation(PCDV Group) were retrospectively analyzed.Meanwhile,the effect of two procedures on PVT was compared.Results The incidence of PVT was 10.0%in combined group and 22.8%in PCDV group (P<0.05).The rebleeding rate from esophagogastric varices because of PVT in combined group was 3.6%,which was significantly lower than that of 10.8%in PCDV group(P<0.05).Conclusion Splenoeaval shunt plus devascularization is a better choice to decrease the incidence of PVT.The postoperative anti-coagulation therapy in the early stage is important for the prevention of PVT.

Objective To evaluate the effects,hemodynamies and hepatic functional reserve of a combined procedure of modified pmximal splenocaval shunt and pericardial devascularlzation (PCDV) in the treatment of portal hypertension.Methods From 1997 to 2007,a total of 255 patients with cirrhotic portal hypertension received combined (135 cases) or PCDV procedure (120 cases,) in our hospital.The clinical results were retrospectively analyzed.Changes of hemodynamics of the portal venous system were studied by Doppler color flow imaging and intraoperative free portal pressure (FPP) measurement.The hepatic functional reserve was evaluated by indocyanine green (ICG) retention ratio and functional hepatic flow(FHF).Results Postoperative mortality was 2.2% in combined group and 4.3% in PCDV group.The long term rebleeding rate was 5.5%as revealed by follow-up in combined group,which was significantly lower than that in PCDV group of 14.1%(P<0.05).The incidence of encephalopathy was 6.4%and 5.4%in combined group and PCDV group respectively(P>0.05).The 1-,3-,5-and 10 year-survival rates were 96.4%,90.0%,81.3%and 62.5% in combined group and 95.7%,86.7%,75.0%,57.1%in PCDV group.In combined group,the FPP、PVF and FHFwere(32.0±1.5)cm H_2O、(880±260)ml/min and(430±1 80)ml/min respectively,a significant decrease when compared with preoperative parameters (P<0.05),while R_(15) (30%±4%)increased (P<0.01).The similar results were observed in PCDV group postoperatively (P<0.05).Compared to PCDV group,the decrease of FPP in combined group was more significant(P<0.05),but the PVF,FHF and R_(15) were not significantly different (P>0.05).Conclusions The combined procedure is safe and effective in treatment of portal hypertension with better clinical outcome,moderate homodynamic changes and good maintenance of hepatic functional reserve.

Objective: To investigate the factors related to cardiac dysfunctions during the percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Methods: Patients diagnosed as NSTEACS receiving PCI from September 2007 to June 2018 were collected in the data base of medical record management system in Qingdao Eighth People′s Hospital. Patients with cardiac dysfunctions (≥ Killip Ⅱ grade) within 1 week after PCI were included into the case group, while patients with normal cardiac function (Killip Ⅰ grade) within 1 week after PCI were included into the control group. Firstly, baseline data of age, gender, histories of hypertension, histories of type 2 diabetes, histories of high cholesterol, histories of smoking, histories of drinking, histories of myocardial infarction, NSTEACS risk stratifications, the application of platelet glycoprotein (GP)Ⅱb/Ⅲa receptor antagonists, coronary artery SYNTAX scores, the dose of contrast agent during PCI, the peak cardiac troponin (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) within 24 h after admission was compared between the two groups; then, factors with statistical differences (P < 0.05) were analyzed by the multivariate logistic regression; at last, variables screening was performed through the backward method and likelihood ratio test. Results: A total of 3927 patients with NSTEACS receiving PCI were enrolled. After patients with incomplete information were eliminated, 313 patients were admitted to the case group and 2 906 patients were admitted to the controlled group. After the analysis of multivariate logistic regression and variables screening, it showed that >80 years old (OR = 1.758, 95% CI 1.129 to 2.367, P = 0.014), increased dose of contrast agent (OR = 1.083, 95% CI 1.007 to 1.274, P = 0.020), the peak cTnT>0.2 μg/L (OR = 2.102, 95% CI 1.703 to 3.104, P = 0.031) and NT-proBNP>450 ng/L (OR = 2.243, 95% CI 1.863 to 3.257, P = 0.015) after admission were the risk factors of cardiac dysfunctions. Conclusions Advanced age (>80 years old), increased dose of contrast agent during PCI, the peak cTnT>0.2 μg/L and NT-proBNP>450 ng/L within 24 h after admission could raise the risk of cardiac dysfunctions in patients with NSTEACS after PCI.

Objective To study the safety and efficacy of damage control using percutaneous transhepatic biliary drainage (PTBD) in acute cholangitis of severe type (ACST) secondary to intrahepatic choledocholithiasis.Methods The clinical data of 8 patients who received PTBD after hospital admission followed by conventional surgery for ACST when their general condition improved were retrospectively studied.Results All patients received PTBD successfully and the amount of bile drained was 100-400 ml in the first day.The general condition of these 8 patients became better after 24 h and the total bilirubin decreased for about 25-100 mmol/L after 48 h.Three patients with a platelet count of less than 20 × 109/L showed an improved count to more than 50 × 109/L 72 h after PTBD.All patients were operated at different times after the PTBD:2 received T-tube drainage,3 T-tube drainage combined with left hepatectomy,and 3 choledochojejunostomy.Seven patients recovered uneventfully,but 1 developed hepatic failure with the total billurubin rose to more than 200 μmol/L.He was discharged home with the PTBD tube.During the waiting time of 7 days to 3 months before surgery,the tubes were kept patent and no mortality or morbidity such as bleeding,bile leakage,and peritonitis occurred.Conclusions PTBD was a safe and efficacious procedure for patients who were in a serious condition with ACST secondary to intrahepatic choledocholithiasis.It was more likely to be successful as it is minimally invasive and therefore well-tolerented.It reduced the biliary pressure,relieved the ongoing sepsis,and was a good preparatory procedure before any conventional surgery.

BACKGROUND:Excessive lateral pressure syndrome is often associated with lateral retinacular tension and radiographic patel ar tilt. CT scan displayed that lateral retinacular release can effectively correct patel ar tilt. OBJECTIVE:To study the effect of arthroscopic lateral retinacular release combined with intraosseous dril ing and decomposition in the treatment of excessive lateral pressure syndrome. METHODS:Thirty-two patients with excessive lateral pressure syndrome were treated by arthroscopic lateral release combined with intraosseous dril ing and decomposition. The Lysholm scoring system was used to evaluate the treatment effect. RESULTS AND CONCLUSION:The mean duration of fol ow-up was 12 months. After 1 month, pain of al patients was released or disappeared;after 1 year, pain of 26 cases disappeared basical y. Lysholm scoring system assessment showed 20 cases were rated as excellent, six cases were as good, four cases were as fair and two cases were as poor. The excellent and good rate was 83.6%. The patients’ subjective satisfaction rate was 92.8%. The results indicate that arthroscopic lateral release combined with intraosseous dril ing and decomposition is a good method to treat excessive lateral pressure syndromewere. It has the advantages of less trauma and rapid recovery. Patel ar decomposition has a good effect in the treatment of patel ofemoral pain associated with patel ar tilt outward and lightens articular cartilage degeneration without damage to patel ar cartilage surface.

Objective To investigate the factors related to slow-flow (SF) or no-reflow (NR) during the percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary sydrome (NSTEACS). Methods Patients diagnosed as NSTEACS who received PCI from September 2007 to June 2018 were collected through the data base of medical record management system in Qingdao Eighth People′s Hospital.The blood flow≤TIMI 2 grade during PCI was defined as slow-flow (SF) or no-reflow(NR). Patients with SF or NR were included into the case group and patients without SF or NR were included into the controlled group. Factors of age, gender, history of hypertension, history of type 2 diabetes, history of high cholesterol, history of smoking, history of drinking, NSTEACS risk stratification, the application of platelet glycoprotein (GP) ⅡB/ⅢA receptor antagonist, coronary artery SYNTAX score, culprit blood vessels, times of balloon dilatation, the burden of thrombus and the preoperative TIMI grade of blood flow were analyzed by multivariate Logistic regression. Then, variables screening was performed through backward method and likelihood ratio test. Results A total of 3 927 patients with NSTEACS receiving PCI were enrolled. After patients with incomplete information were eliminated, 143 patients were admitted to the case group and 3 588 patients were admitted to the control group. After the analysis of multivariate Logistic regression and variables screening, it was showed that times of balloon dilatation ≥ 3 ( OR＝1.725, 95% CI 1.211－2.358, P＝0.014) and high burden of thrombus ( OR＝1.821, 95% CI 1.322-2.511, P＜0.01) were the risk factors of SF or NR, while the application of GPⅡB/ⅢA receptor antagonist ( OR＝0.623, 95% CI 0.382-0.855, P＝0.012) was the protective factor of SF or NR. Conclusions Multiple balloon dilatation and high burden of thrombus increased the risk of SF or NR, while the application of GPⅡB/ⅢA receptor antagonists could inhibit the occurrence of SF or NR.

Objective:To investigate the clinical outcome of transposition of the medial gastrocnemius muscle flap in repairing the middle and upper tibial soft tissue defects.Methods:The clinical data of patients with mid-upper tibial tissue defects admitted to the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from September 2016 to June 2020 were retrospectively analyzed. Doppler ultrasound was used to detect and mark the blood vessels and branches of the lower limbs before surgery, the medial gastrocnemius muscle flap was designed according to the wound condition of the patient, the soft tissue defects in the middle and upper part of the tibia were repaired by transposition, and the appearance, color, feel, texture, gait and plantar flexion strength of the affected foot, as well as the recovery of the donor site were followed up after surgery. For patients with chronic osteomyelitis, the efficacy is evaluated with reference to McKee and other osteomyelitis treatment standards, including three levels: cure, improvement and recurrence.Results:A total of 11 patients were enrolled, including 9 males and 2 females, aged 48 to 69 years. The area of soft tissue defect ranged 3.8 cm×5.7 cm-14.2 cm×7.6 cm, and the flap size ranged 13.0 cm×6.0 cm-21.0 cm×13.0 cm. After surgery, one case had blisters at the distal end, which were cured after conservative measures. Other flaps and donor wounds presented good blood circulation, the shape and function recovered satisfactorily, and the incision healed uneventfully. 11 cases were followed up for 7-18 months after surgery, with an average of 13.2 months, and the appearance, color and texture of the flap were basically satisfactory. The two-point distance perception of the flap was 13-20 mm 9 months after surgery, with an average of 15 mm. At the last follow-up visit, the plantar flexion strength of the affected side was weaker than that of the healthy side, but the gait was basically normal. All 4 patients with chronic osteomyelitis met the clinical cure criteria, and there was no rash, swelling, overheat and pain, rupture, exudation and sinus tract formation at the primary lesion during the follow-up period (average 14 months), and no osteosclerosis and dead bone formation were found on X-ray examination. There was no deformity and dysfunction at the donor site. There was one case presented pigmentation at the donor site of the thigh. Some cases presented superficial scarring.Conclusions:The transposition of the medial gastrocnemius muscle flap repairs the middle and upper tibial tissue defects without sacrificing the major blood vessels, and the flap survival rate is high, the complications are minimal, and the function and morphological recovery of the receiving area are good.

Objective:To investigate the clinical outcome of transposition of the medial gastrocnemius muscle flap in repairing the middle and upper tibial soft tissue defects.Methods:The clinical data of patients with mid-upper tibial tissue defects admitted to the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from September 2016 to June 2020 were retrospectively analyzed. Doppler ultrasound was used to detect and mark the blood vessels and branches of the lower limbs before surgery, the medial gastrocnemius muscle flap was designed according to the wound condition of the patient, the soft tissue defects in the middle and upper part of the tibia were repaired by transposition, and the appearance, color, feel, texture, gait and plantar flexion strength of the affected foot, as well as the recovery of the donor site were followed up after surgery. For patients with chronic osteomyelitis, the efficacy is evaluated with reference to McKee and other osteomyelitis treatment standards, including three levels: cure, improvement and recurrence.Results:A total of 11 patients were enrolled, including 9 males and 2 females, aged 48 to 69 years. The area of soft tissue defect ranged 3.8 cm×5.7 cm-14.2 cm×7.6 cm, and the flap size ranged 13.0 cm×6.0 cm-21.0 cm×13.0 cm. After surgery, one case had blisters at the distal end, which were cured after conservative measures. Other flaps and donor wounds presented good blood circulation, the shape and function recovered satisfactorily, and the incision healed uneventfully. 11 cases were followed up for 7-18 months after surgery, with an average of 13.2 months, and the appearance, color and texture of the flap were basically satisfactory. The two-point distance perception of the flap was 13-20 mm 9 months after surgery, with an average of 15 mm. At the last follow-up visit, the plantar flexion strength of the affected side was weaker than that of the healthy side, but the gait was basically normal. All 4 patients with chronic osteomyelitis met the clinical cure criteria, and there was no rash, swelling, overheat and pain, rupture, exudation and sinus tract formation at the primary lesion during the follow-up period (average 14 months), and no osteosclerosis and dead bone formation were found on X-ray examination. There was no deformity and dysfunction at the donor site. There was one case presented pigmentation at the donor site of the thigh. Some cases presented superficial scarring.Conclusions:The transposition of the medial gastrocnemius muscle flap repairs the middle and upper tibial tissue defects without sacrificing the major blood vessels, and the flap survival rate is high, the complications are minimal, and the function and morphological recovery of the receiving area are good.