AIM:To evaluate the diagnostic value of co-detection of ischemia modified albumin (IMA) and treadmill exercise test (TET) for silent myocardial ischemia (SMI).METHODS:80 patients [55 males and 25 females;mean age (54?8) years] with suspected SMI were selected.All patients were examined with TET and coronary arteriongraphy(CAG) in one week.IMA was detected before TET and two hours after TET.All patients were divided into CHD and NCHD groups combined with the results of CAG.Changes in the concentration of IMA were observed of two groups before and after TET.The diagnostic value of co-detection of ischemia modified albumin and treadmill exercise test was evaluated for SMI.RESULTS:Among the 80 patients,it was diagnosed as CHD 33 cases,NCHD 47 cases.There were significant higher levels of IMA after TET in CHD group (P0.05).IMA levels were significantly higher in the patients of CHD after TET than those patients of NCHD[(13.3?3.5) vs (4.7?1.8) ng/mL,P0.05).The sensitivity value was 81.8% for IMA after TET,specificity was 76.6%,positive predictive value was 71.1%,negative predictive value was 85.7%.The sensitivity was 93.8% with the co-detection of IMA and TET,specificity was 87.5%,positive predictive value was 83.3%,negative predictive value was 95.5%.CONCLUSION:IMA is a useful biochemical marker for the early myocardial ischemia.There is a high sensitivity and negative predictive value for IMA two hours after TET in the diagnosis of SMI.There is much higher diagnostic value with the co-detection of IMA and TET.

OBJECTIVETo investigate the contents of lead, cadmium, zinc and manganese in the follicular fluid and semen of infertile couples that are not professionally exposed to the four heavy metallic elements.

METHODSIn vitro fertilization pre-embryo transfer (IVF-ET) was carried out in wives, and follicular fluid collected after routine oocyte retrieval. Semen was obtained from husbands by masturbation. The contents of zinc in the follicular fluid and semen were determined by the flame atom absorption method and those of lead, cadmium and manganese by graphite furnace atomic absorption spectrometry.

RESULTSThe average concentrations of lead, cad- mium, zinc and manganese were 151.06 microg/L, 2.02 microg/L, 0.54 mg/L and 28.54 microg/L in the follicular fluid, and 250.23 microg/L, 7.42 microg/L, 189.11 mg/L and 82.15 microg/L in the semen. The follicular fluid samples in which lead, cadmium, zinc or manganese was detected constituted 43.8% (21/48), 22.9% (11/48), 75.0% (36/48) and 50.0% (24/48), and the semen samples accounted for 70.2% (33/47), 31.9% (15/47), 100.0% (47/47) and 46.8% (22/47), respectively.

CONCLUSIONThe results suggest that the average contents of lead, cadmium, zinc and manganese are higher in the semen than in the follicular fluid in the non-professionally exposed infertile couples, and so is the percentage of the samples containing each of the elements, with the exception of manganese.

Adult ; Cadmium ; analysis ; Environmental Exposure ; analysis ; Female ; Follicular Fluid ; chemistry ; Humans ; Infertility, Female ; metabolism ; pathology ; Infertility, Male ; metabolism ; pathology ; Lead ; analysis ; Male ; Manganese ; analysis ; Metals, Heavy ; analysis ; Semen ; chemistry ; Spectrophotometry, Atomic ; Zinc ; analysis

OBJECTIVETo study the therapeutic efficacy of manipulative reduction and percutaneous pin fixation for the treatment of severely displaced distal tibial fractures in children.

METHODSFrom May 2009 to December 2012,56 children with severely displaced distal tibial fractures were analyzed, who had been treated with manipulative reduction and percutaneous pin fixation. Preoperative fractures were confirmed as severely displaced fractures by X-ray apparatus. There were 33 boys and 23 girls,ranging in age from 3 to 14 years, with an average of 10.1 years. All the fractures were closed without vascular or nerve injuries. According to the bone fracture type, under C-arm fluoroscopy, functional reduction was achieved by manipulative reduction. The fractures were fixed with percutaneous pins. Postoperative X-ray confirmed the functional reduction. Follow-up indexes were recorded: intra-operative and postoperative complications,postoperative radiographic examination, lower extremity length and range of ankle motion. Ankle score system of Teeny was used to evaluate ankle function.

RESULTSAll the patients were followed up, and the duration ranged from 3 to 46 months, with an average duration of 19.4 months. According to the Teeny score standard, 35 patients got an excellent result, 7 good and 3 fair. Pin track reaction was found in 4 cases. The X-ray showed all the fractures healed without shortening deformity or epiphyseal arrest at early stage. All the patients could participate in the normal physical activities, having a normal range of motion and excellent strength of the ankle joint.

CONCLUSIONThe method of manipulative reduction and percutaneous pin fixation is a safe and convenient treatment for severely displaced distal tibial fractures in children. It has several advantages as follow: micro-trauma, tiny tissue damage, firm fixation, and the patients can exercise the function of ankle early, suggesting that it is an effective treatment method.

Adolescent ; Adult ; Bone Nails ; Child ; Child, Preschool ; Combined Modality Therapy ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Middle Aged ; Tibial Fractures ; surgery

Objective Imatinib mesylate (IM) is the most active agent in treating chronic myeloid leukemia (CML). 5-Aza-2-deoxycytidine (DAC) is a cytosine analogue that inhibits DNA methylation and the activity in myeloid leukemia. Therefore,we investigated combining these two drugs in human leukemia cell line K562. Methods The effects of IM and DAC was examined in K562 cells including cell viability using MTT method,cell cycle phase and cell death using flow cytometric (FCM),and the expression of bcr-abl mRNA by RT-PCR. Results Both DAC and IM resulted in time and concentration-dependent induction of cell death. DAC and IM in combination produced a greater inhibition of growth against K562 cells (F =43.947,165.580,321.193,296.101,P<0.05). The main effect and interaction between two drugs was statistically significant (F = 202.759,168.457,417.538,P <0.001) after 24 h,48 h,72 h and a greater reduction in expression of bcr-abl mRNA than either agent alone. The difference was statistically significant (F =71.981,P <0.05). The number of G1 phase cells were increased significantly when induced by single agent. 48 h incubation with IM 0.2 μmol/L alone or combined with DAC 4 μmol/L showed 6.7 %,8.4 % pre-apoptosis cells,respectively. After incubation for 48 h with DAC 4 μmol/L,the expression of mRNA were decreased by 14 %,IM 0.2 μmol/L showed 40 % reduction,and combination group were significantly depressed for the mRNA expression by 60 %. Conclusion The combination of DAC and IM showed synergistic effects on cell death in K562 cells. These data suggested that DAC used in combination with IM has clinical potential in the treatment of chronic myeloid leukemia.

Objective To observe the perioperative myocardial protection of high-dose atorvastatin to acute coronary syndrome(ACS) patients during percutaneous coronary artery interventional therapy(PCI).Methods One hundred and twenty patients with ACS undergoing elective PCI were divided into group A and group B with different oral dose of atorvastatin ( 80 mg/d and 20 mg/d ) for 3 days before operation by random digits table. Troponin I (cTnI), creatine kinase isozyme MB (CK-MB), high sensitive C-reactive protein (hs-CRP), interleukin (IL)-6 levels were measured before operation, 6 hours, 12 hours after operation and total cholesterol (TC), triglyeride (TG), low desity lipeprotein cholesterol (LDL-C), high density lipeprotein cholesterol (HDL-C) levels were measured before operation and 3 days after operation.Results cTnI,CK-MB,hs-CRP and IL-6 levels in the two groups were increased significandy 6 hours and 12 hours after operation (P <0.05). Six hours after operation, cTnI and CK-MB levels in group A were significantly lower than those in group B [(0.35±0. 18 ) μg/L vs. (0.48±0. 16 ) μg/L, ( 3.78±0.45 )μg/Lvs. (4.56±0.55 )μg/L] (P < 0.05 ). Twelve hours after operation , hs-CRP and IL-6 levels in group A were significantly lower than those in group B [(4.53±0.98 ) mg/L vs. (7.03±0.88 ) mg/L, ( 30.6±11.2) ng/L vs.(43.8±12.1) ng/L] (P <0.05). TC, TG, LDL-C, HDL-C levels in the two groups did not change significantly before and after operation (P >0.05). Conclusions Myocardial protective effects of ACS patients treated with atorvastatin 80 mg/d for 3 days are better than those treated with oral atorvastatin 20 mg/d. High-dose atorvastatin can produce more beneficial effects.

Thorough excavation and artful utilization of various kinds concrete and invisible learning resources contribute to the cultivation of excellent postgraduates.In postgraduate education of anesthesiology Xuzhou Medical College utilizes time,network,technique platform,research outcome,self-potentiality and clinical patients resources,which produces an active effect and has important instructional significance.

Objective To assess the value of three-dimensional multislice CT angiography (CTA) in evaluating the therapeutic effect of intracranial aneurysm clipping and explore a convenient, safe and reliable method for the postoperative evaluation. Methods Of the 120 patients with intracranial aneurysms hospitalized from January, 2006 to March, 2007 in our hospital, 52 patients were treated with aneurysm clipping using titanium clips. Follow-up study for 2-38 weeks (mean 15±11weeks) was conducted in 20 of the patients with 21 aneurysms (1 patient had multiple aneurysms), including 1 in the anterior cerebral communicating artery, 7 in the posterior cerebral communicating arteries, 2 in the M3 segment of the middle cerebral arteries, 1 in the anterior choroidal artery, and 1 near the AI segment. Three-dimensional multislice CTA was performed in these patients, and the location of clips, patency of the proximal and distal segments of the parent arteries, presence of the remnant necks and domes of the aneurysms were evaluated with maximum intensity projection (MIP) and volume rendering (VR). Results The locations of 20 aneurysm clips were well visualized, and one clip was not clearly shown due to the artifacts of the clip and coils. All the proximal and distal segments of the parent arteries were clearly visualized and the relationship between the clips and the aneurysms was well demonstrated by MIP and VR in CTA. No remnant domes of the clipped aneurysms were found in these patients. Conclusion Three-dimensional multislice CTA provides an important means for postoperative evaluation of intracranial aneurysms treated with titanium clips and have great value in clinical practice.

OBJECTIVETo compare two techniques of the transarticular screw placement in the lower cervical spine, and to suggest and confirm a new technique of the placement.

METHODSThe techniques of transarticular screw placements used by Takayasu (group A) and Dalcanto (group B) were applied in eight cervical specimens. The splits of facets,the encroachment of the cervical nerve roots and transverse foramens were observed and analyzed. The numbers of transarticular screws which not gone through the facets were counted in both group A and B, respectively.

RESULTSSixty-four transarticular screws were implanted,thirty-two for group A, the same for group B. Although no splits of the facets were seen in group A, two transarticular screws did not go through the facets. There were ten splits of facets in group B, in which seven involved the inferior border of the inferior facets and three for the lateral border. No superior facets were found to be broken both in group A and B. Eight screws encroached the transverse foramens in group A and none in group B. Eleven of anterior branch and eight of posterior branch of lower cervical nerve roots were involved in group A, two and nine respectively in group B.

CONCLUSIONThere are high risk of injury of anterior branch of cervical nerve root and vertebral artery if the screws are too long and the Takayasu's technique is used. However, the rate of facet split is high if the Dalcanto's technique is applied.

Aged ; Aged, 80 and over ; Bone Screws ; Cervical Vertebrae ; surgery ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged

BACKGROUND AND OBJECTIVECombined hypoxic cytotoxic drugs and chemoradiotherapy is an important mean of oncotherapy, and Tirapazamine (TPZ) is one of the most remarkable drugs. It has been shown that TPZ has a synergistic effect with radiotherapy on tumor cells, but whether TPZ would down-regulate the expression of the hypoxia-induced genes has not been reported. This study was to investigate the hypoxia-induced mRNA expressions of hypoxia inducible factor-1alpha (HIF-1alpha) and osteopontin (OPN) in human nasopharyngeal carcinoma HNE-1 and CNE-1 cells and the radiosensitization of TPZ, a hypoxia-specific drug, on HNE-1 and CNE-1 cells in vitro.

METHODSThe IC50 values of TPZ for HNE-1 and CNE-1 cells were measured using MTT assay, and the mRNA expressions of HIF-1alpha and OPN in HNE-1 and CNE-1 cells was determined using RT-PCR under aerobic and hypoxic conditions, respectively. The survival rates of HNE-1 and CNE-1 cells treated with or without TPZ at IC10 in the presence or absence of oxygen for 6 h were determined using colony formation assay following exposure to 1-6 Gy of 60Co radiation. The dose-survival curves were plotted and the values of D0, Dq and SER were calculated as a single-hit multitarget model.

RESULTSThe IC50 values of TPZ were 34.81 μmol/L and 35.02 μmol/L in HNE-1 and CNE-1 cells under aerobic condition, and 30.20 μmol/L and 28.48 μmol/L under hypoxic condition, respectively. The expressions of HIF-1alpha and OPN mRNA were reduced by TPZ in HNE-1 cells, but not in CNE-1 cells under hypoxic condition. For the HNE-1 cells, the respective values of D0 and Dq were 0.89 Gy and 0.28 Gy following normoxic irradiation versus 1.47 Gy and 0.44 Gy following hypoxic irradiation. For the CNE-1 cells, the respective values of D0 and Dq were 0.72 Gy and 0.68 Gy following normoxic irradiation versus 0.95 Gy and 0.56 Gy following hypoxic irradiation. The values of D0 and Dq for HNE-1 and CNE-1 cells treated with TPZ under hypoxic condition following irradiation were 0.66 Gy, 0.21 Gy and 0.85 Gy, 0.79 Gy, respectively.

CONCLUSIONTPZ can down-regulate hypoxia-induced expression of HIF-1alpha and OPN mRNA of HNE-1 cells and radiosensitize the HNE-1 cells but not CNE-1 cells, and act as a hypoxia modifier.

Antineoplastic Agents ; pharmacology ; Cell Hypoxia ; Cell Line, Tumor ; Cell Survival ; drug effects ; radiation effects ; Cobalt Radioisotopes ; Down-Regulation ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; genetics ; metabolism ; Inhibitory Concentration 50 ; Nasopharyngeal Neoplasms ; metabolism ; pathology ; Osteopontin ; genetics ; metabolism ; RNA, Messenger ; metabolism ; Radiation Tolerance ; drug effects ; Radiation-Sensitizing Agents ; pharmacology ; Triazines ; pharmacology

Objective To discuss the key points of endovascular therapy for complex subclavian artery occlusive diseases. Methods During the period from January 2012 to December 2013, a total of 92 patients with complex subclavian artery occlusive disease were admitted to Xuanwu Hospital of Capital Medical University, Beijing, China. The clinical data were retrospectively analyzed. The features of the lesions, the success rate of endovascular therapy, the use of combined approaches, the relief of symptoms after treatment, etc. were evaluated. Results The complex subclavian artery occlusive diseases could be divided into three types. Type Ⅰ: long segment of the left subclavian artery was occluded; type Ⅱ: ostial stenosis or occlusion of the right subclavian artery; and type Ⅲ: subclavian artery stenosis or occlusion was associated with the ostial disorder of the vertebral artery, or the opening of vertebral artery was affected by the subclavian artery stenosis or occlusion. The technical success rate was 82.6%. Combination use of femoral artery and brachial artery approach was employed in 27.2% of patients, which had improved the technical success rate. After the treatment the symptom improvement rate was 81.6%. Conclusion Upper limb artery approach can improve the re-canalization rate of left subclavian artery with long segment occlusion, and can ensure the accurate positioning of stent at the site of right subclavian artery opening. During the procedure of endovascular intervention for subclavian artery occlusion disease, attention should be paid to the protection of the vertebral artery.