BACKGROUND:The appearance of biodigradable stents brings a new dawn for the fourth coronary intervention revolution. They not only can solve the problem of postoperative acute occlusion of blood vessels, but also can be completely absorbed after a certain time.
OBJECTIVE: To summarize the application status of biodegradable coronary stents.
METHODS:PubMed, CBM and embase were searched for articles related to biodegradable intravascular stents.
RESULTS AND CONCLUSION:Biodegradable polymer stents, biodegradable magnesium stents and biodegradable iron stents are currently the three major research biodegradable stent systems. Numerous clinical trials have demonstrated the long-term safety and reliability of the biological degradation stents, and in the near future they wil replace the existing drug-eluting stents as the primary means of percutaneous coronary intervention. Biodegradable stents currently stil have their limitations, which are reflected in the relationship between mechanical properties and degradation rate and cannot be applied to complicated coronary patients temporarily. It takes 6-12 months to restore normal physiological function of blood vessels, and it can be considered reasonable that degradation of stents is completed in 12-24 months. Poly(lactic-co-glycolic) produced by polylactic acid and polyglycolic acid is currently widely recognized as the stent’s framework. We can get a more appropriate balance between the mechanical properties of the stent and the degradation rate by adjusting the ratio of polylactic acid and polyglycolic acid. This stent not only has good mechanical properties, but also can be completely biodegradable after the restoration of normal function of blood vessels, which has a broad research space.

AIM To research the therapeutic effects of Hanbi Formula (Astragali Radix,Aconiti Radix cocta,Scorpio,Scolopendrap and Pheretima) on adjuvant-induced arthritis rats (RA) and its mechanism of action.METHODS RA rat models were established by using Freund's adjuvant,and then the rats were divided into six groups,namely control group,model group,dexamethasone positive group,Baoguang Fengshi Liquid (Notopterygii Rhizoma et Radix,Radix angelicae pubescentis,Chuanxiong Rhizoma,etc.) positive group,and low,high doses of Hanbi Formula groups.The volume and swelling of toes were measured.The interleukin-1 β (IL-1β) and tumor necrosis factor-α (TNF-α) of serum were detected by ELISA;the proliferative capacity of lymphocytes was tested by methyl thiazolyl tetrazolium (MTI) method;synovial tissue was histopathologically examined with HE staining.Finally,the expressions of interleukin-17 (IL-17) and TNF-α in synovial tissue were determined by immunohistochemical assays.RESULTS Hanbi Formula could significantly relieve toe swelling of RA rats.Compared with the model group,Hanbi Formula could significantly alleviate synovitis in rats with RA,down-regulate the expressins of IL-1 β and TNF-α in serum and synovial tissue,and inhibit lymphocyte proliferation.There were no significant differences in above indices between low-dose and high-dose Hanbi Formula groups,which was quite with Baoguang Fengshi Liquid,but less than dexamethasone.CONCLUSION Hanbi Formula possesses an obvious function of anti-RA,and its mechanism may be related to the inhibition of lymphocyte proliferation and reducing secretion of inflammatory cytokines.

Objective To explore the in-vivo hemodynamic and hemolysis effect of a newly designed axial continuousflow ventricular assist device(VAD) in swine.Methods Under general anesthesia,each of 5 swine [weight (40.0 ± 5.2)kg] was implanted with the axial continuous-flow VAD into the apex of left heart ventricle,and the outflow graft was anastomosised to descending aorta.Results All of the axial continuous-flow VAD were implanted successfully with post-operative survival rate 100％.All 5 animals survived over one week.There was a positive correlation between pump speed and assistance effect.The mean left ventricular systolic pressure was (131.6 ± 28.0) mmHg(1 mmHg =0.133 kPa).While the axial continuous-flow VAD was working,left ventricular end diastolic pressure decreased,along with mean intraventricular pressure declined.Peripheral hemodynamics was stable and peripheral blood pressure was not remarkably different from the pressure preoperation.Daily urine volume was in normal range within 1 week post operation.Free hemoglobin in plasma was slightly elevated on the surgery day,and gradually dropped to normal level within 1 week.International Normalized Ratio(INR) was maintained between 2.0-2.5 with oral adminiatration of warfarin of 3 mg/day.There was no thrombosis existing in VAD at autopsy.Conclusion The application of the axial pump with hydrodynamic-magnetically levitated impeller in animal experiment can provide stable hemodynamics,advanced heart unloaded effect,favorable peripheral perfusion,and blood compatibility is satisfactory.

Objective To investigate the efficacy of double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula.Methods The retrospective cohort study was adopted.The clinical data of 208 patients who underwent pancreaticojejunostomy at the Hunan Provincial People's Hospital from March 2011 to March 2015 were collected.Of 208 patients,106 patients undergoing double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy were allocated into the double-“ U” group and 102 patients undergoing Child pancreaticojejunostomy were allocated into the Child group.Observation indicators included (1) surgical effects:anastomosis time,postoperative pancreatic leakage,duration of hospital stay,(2) follow-up situations.The follow-up using telephone interview and outpatient examination was performed to detect postoperative long-term complications and recovery of patients by abdominal ultrasound or computed tomography (CT) at every 6 months postoperatively up to September 2015.Measurement data with normal distribution were represented as x ± s and comparison between groups was analyzed by t test.Count data were analyzed using the chi-square test.Results (1) Surgical effects:208 patients underwent successful surgery without occurrence of death.The anastomosis time was (13.0 ± 1.5) minutes in the double-“ U” group and (20.0 ± 1.6) minutes in the Child group,with a statistically significant difference between the 2 groups (t =4.713,P ＜ 0.05).Two patients in the double-“ U” group were complicated with grade A of pancreatic leakage,including 1 of 36 patients with normal pancreatic remnant and 1 of 70 patients with fibrotic pancreatic remnant.Nine patients in the Child group were complicated with pancreatic leakage,including 6 in grade A,1 in grade B and 2 in grade C,and there were 6 of 33 patients (4 in grade A,1 in grade B,1 in grade C) with normal pancreatic remnant and 3 of 69 patients (2 in grade A,1 in grade C) with fibrotic pancreatic remnant.There were statistically significant differences in the pancreatic leakage between the 2 groups and among the patients with normal pancreatic remnant in the 2 groups (x2 =2.951,4.994,P ＜ 0.05).The duration of postoperative hospital stay was (13.5 ± 1.2)days in the double-“U” group and (15.7 ± 2.6)days in the Child group,with a statistically significant difference (t =1.011,P ＜ 0.05).No readmission in the 2 groups occurred.(2) Followup situations:91 of 106 patients in the double-“U” group were followed up for 6-54 months with a median time of 30 months.During the follow-up,8 patients were dead,12 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,4 and 4 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Eighty-eight of 102 patients in the Child group were followed up for 6-54 months with a median time of 25 months.During the follow-up,10 patients were dead,11 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,6 and 6 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Conclusion Double“U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula can reduce the suture time,incidence of pancreatic leakage and duration of postoperative hospital stay,and it is especially suitable for the patients with normal pancreatic remnant.

Objective To investigate the efficacy of duodenum-preserving pancreatic head resection (DPPHR) for the treatment of chronic pancreatitis combined with type Ⅰ and Ⅲ pancreatic duct stones.Methods The clinical data of 55 patients with chronic pancreatitis and type Ⅰ and Ⅲ pancreatic duct stones who were admitted to the People's Hospital of Hunan Province from June 2008 to June 2013 were prospectively analyzed.All the patients were randomly divided into the pancreatoduodenectomy (PD) group (27 patients) and the DPPHR group (28 patients).There were 18 patients with chronic pancreatitis and type Ⅰ pancreatic duct stones and 9 patients with chronic pancreatitis and type Ⅲ pancreatic duct stones in the PD group.There were 16 patients with chronic pancreatitis and type Ⅰ pancreatic duct stones and 12 patients with chronic pancreatitis and type Ⅲ pancreatic duct stones in the DPPHR group.Patients in the PD group received PD + Child anastomosis + end-toside pancreato jejunal anastomosis + pancreatic stent placement + end-to-side cholangiojejunostomy.Patients in the DPPHR group received free of duodenum + pancreatic duct incision + resection of pancreas at 1 cm ahead of the pancreatic duct + extraction of the pancreatic duct stones + pancreaticoduodenal Roux-en-Y anastomosis.Patients were followed up via out-patient examination till December 2013.The measurement data were analyzed using the t test or Mann-Whitney U test,and the count data were analyzed using the chi-square test.Results During the operation,2 patients in the PD group were converted to the DPPHR group and 1 patient in the DPPHR group was converted to the PD group.No patient died during the perioperative period,and the symptoms including abdominal pain and diarrhea were alleviated at postoperative week 2.The operation time,blood loss,duration of postoperative hospital stay,total expenses and incidence of complications were (7.5 ± 1.6) hours,(460 ± 88) mL,(18.0 ± 3.5) days,(7.8 ± 2.1) × 104 yuan,19.2％ (5/26) in the PD group,and (4.0 ± 1.0) hours,(120 ± 36) mL,(9.5 ± 2.9) days,(3.9 ± 1.2) × 104 yuan,3.4％ (1/29) in the DPPHR group,there were no significant differences in the operation time,blood loss,duration of hospital stay,total expenses and incidence of complications between the 2 groups (t =9.358,11.365,6.325,8.647,x2 =3.976,P ＜ 0.05).Fifty-three patients were followed up,with the median time of 33 months (range,6 months to 5 years).No patient died during the follow-up.Twenty-four patients in the PD group were followed up,2 patients had slight abdominal pain,1 patient had severe abdominal pain due to pancreatic duct stenosis,and the symptom was alleviated after resection of partial pancreas ; the condition of 12 patients was improved among the 19 patients with diabetes.Twenty-nine patients in the DPPHR group were followed up,2 patients had slight pain; the condition of 16 patients were improved among the 22 patients with diabetes.Conclusion DPPHR is an ideal surgical procedure for patients with chronic pancreatitis and type Ⅰ and Ⅲ pancreatic duct stones.

e chain-link flap is the good way in the treatment of large areas of the lower leg soft tissue defects.

Objective To investigate the risk factors of postoperative hemorrhage after pancreatoduodenectomy (PD).Methods The retrospective case-control study was adopted.The clinical data of 857 patients with pancreatic diseases who were admitted to the First Affiliated Hospital of Hunan Normal University from January 2007 to December 2014 were collected.All the 857 patients underwent PD and digestive tract reconstruction using the Child method.The number of patients with postoperative hemorrhage,classification,bleeding sites,source and time of bleeding and method and effect of treatment after PD were observed.The correlations among the gender,age,concomitant diseases (diabetes and hypertension),malignancy degree of tumor,the preoperative levels of serum alanine transaminase (ALT),total bilirubin (TBil),albumin (Alb) and prothrombin time (PT),international normalized ratio (INR),operation time,volume of intraoperative blood loss,method of pancreatic and jejunal anastomosis and postoperative hemorrhage after PD were analyzed.The follow-up of outpatient examination and telephone interview was performed to observe postoperative recovery of patients for 2 months till February 2015.Univariate analysis and multivariate analysis were done using the chisquare test and Logistic regression model,respectively.Results Of 72 patients with postoperative hemorrhage,grade A,B and C hemorrhage were detected in 3,41 and 28 patients,respectively,and 41,29 and 2 patients had respectively enteral hemorrhage,parenteral hemorrhage and enteral and parenteral hemorrhage.After PD,38 patients had hemorrhage located at the gastrointestinal tract,9 at the common hepatic artery,proper hepatic artery and gastroduodenal artery (5 due to pseudoaneurysm),5 at the pancreatic section,3 at the jejunal mesenteric vessels,2 at the middle colic arterial branches,1 at the superior mesenteric artery,1 at the superior mesenteric vein and 13 at the ambiguous bleeding sites.The early and late stage hemorrhages (within postoperative hour 24 and after postoperative hour 24) were detected in 20 and 52 patients,respectively.Of 44 patients with grade A and B of hemorrhages,17 underwent conservative treatment,16 underwent reoperation,8 underwent hemostatic therapy under gastroscopy,3 underwent interventional treatment.All the 44 patients had good hemostasis effect.Of 28 patients with grade C of hemorrhage,interventional treatment,reoperation,hemostatic therapy under gastroscopy,conservative treatment,interventional treatment + reoperation and gastroscopy + interventional treatment were applied to 10,7,4,3,3 and 1 patients,respectively.Ten of 28 patients died and 18 had successful hemostasis.The gender and preoperative levels of ALT and TBil were related factors affecting postoperative hemorrhage after PD in the univariate analysis (x2 =4.516,7.585,7.209,P ＜ 0.05).Male,preoperative ALT ≥ 172 U/L and preoperative TBil ≥ 159 μmol/L were the independent risk factors affecting postoperative hemorrhage after PD in the multivariate analysis (HR =2.033,1.860,1.872,95％ confidence interval:1.237-3.341,1.135-3.047,1.060-3.307,P ＜ 0.05).Fifty of 62 patients were followed up for a median time of 2 months with a follow-up rate of 80.6％ (50/62),and no rehemorrhage was occurred.Conclusion Male,preoperative ALT≥172 U/L and preoperative TBil≥≥ 159 μmol/L are the independent risk factors affecting postoperative hemorrhage after PD.

Objective To investigate the effects of sevoflurane pretreatment on the inflammatory response in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB) and the mechanism of myocardial protection.Methods Twenty NYHA class Ⅱ or Ⅲ patients of both sexes,aged ＜ 60 yr,undergoing cardiac valve replacement with CPB,were randomly divided into 2 groups (n=10 each): sevoflurane group (group S) and control group (group C).The patients were premedicated with intramuscular morphine 0.1 mg/kg and scopolamine 0.3 mg.Anesthesia was induced with iv injection of midazolam 0.05-0.08 mg/kg,fentanyl 10-15 μg/kg and pipecuronium 0.08-0.10 mg/kg.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with intermittent iv boluses of midazolam0.03-0.06 mg/kg,fentanyl 5-10μg/kg and pipecuronium 0.04-0.08 mg/kg.Sevoflurane was inhaled before aortic clamping and the end-tidal concentration was rapidly adjusted to 1.0％ and maintained at this level for 30 min in group S.Blood samples were taken from the central vein before skin incision,immediately after aortic clamping,immediately after aortic unclamping and at 30 min after aortic unclamping,at 2,6,12 and 24 h (T1-8) after operation for determination of the concentrations of plasma tumor necrosis factor-α (TNF-α),interleukin-6 (IL) and interleukin-8 (IL-8),intercellular adhesion molecule-1 (ICAM-1),cardiac troponin I (cTnI) and activity of creatine kinase MB (CK-MB).The requirement for cardiovascular drugs was recorded after release of aortic cross clamp.Results Compared with group C,the plasma concentrations of TNF-α,IL-6 and IL-8 were significantly decreased at T3-8,the plasma concentrations of ICAM-1 and cTnl were significantly decreased at T4-8,the activity of plasma CK-MB was significantly decreased at T8,and the requirement for cardiovascular drugs was significantly reduced after release of aortic cross clamp in group S (P ＜0.05).Conclusion Sevoflurane pretreatment can inhibit the inflammatory response and provide myocardial protection to some extent in patients undergoing cardiac valve replacement with CPB.

OBJECTIVETo detect potential mutations in six patients with citrullinemia.

METHODSGenomic DNA was extracted from peripheral blood samples from the patients. Mutations of the ASS1, ASL and SLC25A13 genes were screened using microarray genotyping combined with direct sequencing.

RESULTSOne patient was diagnosed with argininosuccinate lyase deficiency, and has carried a homozygous c.1311T>G (p.Y437*) mutation of the ASL gene. The remaining five patients were diagnosed with neonatal intrahepatic cholestasis due to citrin deficiency, and have respectively carried mutations of the SLC25A13 gene including [c.851-854delGTAT+c.851-854delGTAT], [c.851-854delGTAT+IVS6+5G>A], [c.851-854delGTAT+IVS16ins3kb], [c.851-854delGTAT+IVS6-11A>G] and [c.851-854delGTAT+c.1638-1660dup23]. Among these, the c.1311T>G mutation was first identified in the Chinese population, and the IVS6-11A>G mutation was a novel variation which may affect the splicing, as predicted by Human Splicing Finder software.

CONCLUSIONThis study has confirmed the molecular diagnosis of citrullinemia in six patients and expanded the mutational spectrum underlying citrullinemia.

Argininosuccinate Lyase ; genetics ; Argininosuccinate Synthase ; genetics ; Citrullinemia ; genetics ; DNA Mutational Analysis ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Mitochondrial Membrane Transport Proteins ; genetics ; Mutation

Objective To establish CRRT nursing quality evaluation index system based on the structure-process-outcome theory, so as to guide clinical nursing and evaluate CRRT nursing quality. Methods Based on structure-process-outcome theory,the evaluation index system was established by literature review,expert group discussion, Delphi method and semi-structural interviews with 10 nursing staff. Results The returning rates of questionnaires in the first and second round expert consultation were 94.29％(33/35) and 97.14％(34/35), respectively. The authority coefficient of the experts was 0.89, and the coordination coefficient of experts' opinion was 0.294. The program included 3 first indexes, 15 second index and 73 items. Conclusions The result of the study can provide evaluation for the clinical nursing operation.