Cardiovascular disease has become the first cause of human death.Among the many risk factors in coronary heart disease,depression has been identified as an independent prognostic risk factors.In patients with coronary heart disease accompanied by severe depression,the onset of angina,quality of life deterioration and the mortality will increase by 3～5 times.However,the majority of antidepressant drugs have adverse effects on cardiovascular disease adverse drug reactions,making coronary heart disease patients with depression,did not receive antidepressant treatment due.So more researches to clarify the anti-depressant drugs,safety for cardiovascular disease are needed.

Objective To study the methods and significance of motor and sensory areas mapping by optical intrinsic signal imaging (IOSI) and neuromonitoring (IOM) during the operation on the lesions near the central sulcus. Methods Intraoperative neuromonitoring were firstly used to map the central sulcus and motor cortex in 5 patients with glioma undergoing surgery. Then, intrinsic optical signals imaging were used to locate the postcentral gyrus. According to the results of mapping, microsurgical operation was chosen for the resection of glioma and postoperative functional results were evaluated. Results All the patients acquired accurate location of central sulcus, motor cortex and somatosensory cortex. The enhanced MRI performed within 24 hours postsurgery showed total resection in 5 cases. The motor and somatosensory function of 5 patients returned to normal after 3-12 months. Conclusion Intraoperative location of the somatosensory area and motor area by optical intrinsic signal imaging and neuromonitoring is a reliable and safe method.

BACKGROUND:Umbilical cord stem cel s mainly derive from ful-term infants, and common culture methods include tissue-attached method and trypsin-digestion mehod. However, effects of different culture methods on the separation of umbilical cord mesenchymal stem cel s remain many disputes. OBJECTIVE:To observe the effects of different culture methods on umbilical cord mesenchymal stem cel s. METHODS:Umbilical cords of 30 healthy ful-term and caesarean delivery infants were selected, and cultured using tissue-attached method or trypsin-digestion method to isloate and culture human umbilical cord mesenchymal stem cel s. Meanwhile, cel growth was measured by flow cytometry. RESULTS AND CONCLUSION:The fusiform-shaped cel s began to separate from the umbilical cord tissue that was primary cultured using tissue-attached method, and 10 days later, the cel fusion reached 80%;after the umbilical cord was cultured using col agenase-trypsin digestion for 5 days, a smal amount of adherent cel s with different shapes appeared, and the fiber-like cel s reached 80%of confluence until 2-week culture. There was no significant difference in the growth of umbilical cord mesenchymal stem cel s cultured by different culture methods (P>0.05). Moreover, cel s cultured by two methods were al positive for CD13, CD29, CD44 and CD105. These results demonstrate that human umbilical cord mesenchymal stem cel s exhibit a high success rate in primary culture using tissue-attached method, which is superior to the trypsin-digestion method.

Objective To analyse clinical features of 86 cases of intracranial arteriovenous malformation (AVM) and explore strategies and methods of the microsurgical treatment of intracranial arteriovenous malformations.Methods The clinical data of 86 intracranial arteriovenous malformation from January 2010 to January 2013 were retrospectively reviewed.For diagnosis,computed tomography (CT) with angiography (CTA),and DSA were used,which could provide real size,location,feeding arteries and draining veins of AVM,and apply NEPM to evaluate the nerve function,assess the qualitative and quantitative flow rate of AVM and surrounding blood vessels by Doppler ultrasonography and fluorescein angiography,and reveal opography of AVM.Operative techniques were used including embolization,feeding artery control.Results Eighty-six cases of AVM were resected successfully under mutitechnology.Following-up demonstrated excellent neurological outcomes in 70 cases,nine case had mild disability,five cases had severe disability,two dead cases.DSA shows resected completely,and long-term follow-up was still in progress,conclusion Multi-technology combined microsurgical techniques which can effective improve the outcomes of intracranial arteriovenous malformations.

Objective To compare the outcome of double Endobutton plate versus clavicular hook plate (CHP) in treatment of Tossy grade Ⅲ acromioclavicular dislocation.Methods A cohort of 82 patients with Tossy grade Ⅲ acromiocavicular dislocation treated between January 2010 and August 2012 were reviewed retrospectively.Based on the treatment choices,the patients were divided into double Endobutton group (36 cases) and CHP group (46 cases).Operative situation,in-hospital parameters,and postoperative visual analogue scale (VAS) of the shoulder,shoulder abduction-rise or anteflexionrise,Constant-Murley shoulder score as well as complications were evaluated.Results There were no statistical differences between the two groups in aspects of operation time,intraoperative blood loss,and length of stay.Mean time to return to work was (13.1 ± 1.4) weeks in double Endobutton group,shorter than (15.5 ±2.6) weeks in CHP group (P ＜0.01).No statistical difference was observed for postoperative complications between the two groups.At postoperative 12 months,VAS was lower in double Endobutton group [(2.1 ± 0.7) points] vs CHP group [(2.9 ± 0.8) points,P ＜ 0.05],but abductionrise and anteflexion-rise were higher in double Endobutton group [(138.6 ± 15.7) °,(140.3 ± 17.6) °] vs CHP group [(91.7 ±8.4)°,(96.7 ± 10.5)°,P＜0.05].Conclusion To treat Tossy grade Ⅲ acromioclavicular dislocation,double Endobutton plate is associated with less shoulder pain,quicker recovery,better shoulder function restoration compared with CHP and there is no need for a second surgery to remove it.

Objectve To explore the application of exercise test use in diagnosis of periodic paraly sis.Methods Forty five cases of hypokalemic periodic paralysis were collected,and 40 health persons as control group.Both groups were measured serum potassium,serum creatase and thyroid function tests.All of them were taken exercise test (ET) and observe 50 minutes,measured before and after the test to seek the changes of compound muscle action potentials (CMAP),and its decreased more than 33％ were considered abnormal.The application of exercise test use was analyzed in diagnosis of periodic paralysis.Results In patients with periodic paralysis,the incidence of ET positive was higher than the control subjects (80％ vs 3.3％,P ＜ 0.001).This trend was significant after 20 minutes,such as 30 min[(37.8 ± 13.2)％ vs (6.2±3.2)％,P＜0.01],40min [(40.3 ±17.6)％ vs (3.2±1.9)％,P＜0.01],50min [(45.26 ± 19.9) ％ vs (-5.1 ± 2.6) ％,P ＜ 0.01].Moreover,linear correlation analysis showed that the serum potassium had negative correlation with serum creatase (r =-0.483,P =0.024).ALL of symptoms improved after a week treatment,the ET positive rate was still higher in patients with periodic paralysis than the control subjects (80.0％ vs 71.1％,P =0.824).Conclusions Exercise test was one of the important objective basis in the diagnosis of low potassium type periodic paralysis,and was not affected by treatment and testing time.

OBJECTIVE:To ensure the stability of electronic data capture(EDC)system in drug clinical trials and to improve the quality of drug clinical trials. METHODS:The quality control system for EDC system was established and introduced from the formulation of quality control process,establishment of data standard,trial project management,daily management,trial project design,system operation,system function,etc. RESULTS & CONCLUSIONS:Data standard have been achieved through estab-lishing EDC quality control system by our hospital based on attributable,legible,contemporaneous,original and accurate principle. The management of trial project and daily management are conducted through data registration,staff training,the formulation of da-ta management plan,fault emergency treatment,database backup;multiple verification of support data,data lock and export,trial report autogeneration and other functions have been realized by formulating related standard operation instruction,program file,op-eration manual and quality record. Those aspects improve facticity,accuracy and integrality of data in clinical trials,and lay a foun-dation for further data mining.

Objective To investigate the effect of parecoxib on postoperative hyperalgesia induced by remifentanil-based anesthesia.Methods One hundred ASA Ⅰ or Ⅱ patients,aged 21-64 yr,weighing 50-80 kg,undergoing elective laparoscopic operation,were randomly divided into 5 groups ( n =20 each):parecoxib group (group P),small dose remifentanil group (group S),large dose remifentanil group (group L),small dose remifentanil + parecoxib group (group SP) and large dose remifentanil + parecoxib group (group LP).Parecoxib 40 mg was injected intravenously at 30 min before anesthesia in groups P,SP and LP.Anesthesia was induced with midazolam0.05 mg/kg,etomidate 0.2 mg/kg,cisatracurium 0.15 mg/kg and remifentanil 1 μg/kg (fentanyl 4 μg/kg in group P).The patients was tracheal intubated and mechanically ventilated.PETCO2 was maintained at 35-45 mm Hg.Anesthesia was maintained with infusion of remifentanil at 0.05 μg·kg-1 ·min-1 (in groups S and SP) or at 0.3 μg· kg- 1· min- 1 (in groups L and LP) combined with inhalation of sevoflurane and infusion of cisatracurium at 0.12 mg·kg-1·h-1.At 30 min after operation,numeric rating scale (NRS) was used to assess the degree of pain at rest and during activity.Tramadol 1.5 mg/kg was injected intravenously after operation if needed.NRS scores were maintained ≤5.The use of tramadol and adverse effects during 24 h after operation were recorded.Results Compared with group P,NRS scores at rest and during activity were significantly increased at 30 min after operation in groups S and L,the incidence of shivering and the number of patients who needed tramadol were significantly increased in group L,and no change was found in NPS scores at rest and during activity at 30 min after operation,the incidence of adverse effects and the number of patients who needed tramadol in groups SP and LP.Compared with group S,NRS scores at rest and during activity at 30 min after operation,the incidence of shivering and the number of patients who needed tramadol were significantly increased in group L,NRS scores at rest and during activity at 30 min after operation were significantly decreased and no change was found in the incidence of adverse effects and the number of patients who needed tramadol in group SP.Compared with group L,NRS scores at rest and during activity at 30 min after operation,the incidence of shivering and the number of patients who needed tramadol were significantly decreased in group LP.Conclusion Intravenous injection of parecoxib 40 mg at 30 min before anesthesia can attenuate postoperative hyperalgesia induced by remifentanil-based anesthesia.

ObjectiveTo discuss the application of neurophysiological monitoring (NEPM), intraoperative color Doppler ultrasonography, fluorescein angiography and neuroendoscope in clinical effects of intracranial giant aneurysm microsurgey. MethodsTo retrospectively review the clinical data of 17 intracranial giant aneurysm. Pre-operative imaging were used, including 3D- CTA, MRI and DSA, to make dectection and delineation of the aneurysm.The NEPM to evaluate the nerve function,assess the qualitative and quantitative flow rate of aneurysm and surrounding blood vessels by Doppler ultrasonography and fluorescein angiography,and reveal opography of aneurysm,protect the considerable perf.vessels and nerves by neuroendoscope.Operative techniques were used including parent artery control,aneurysm neck forming,aneurysm decompression and resection,obliteration of aneurysm with multiple clips and vasospasm protection.Results Seventeen cases of giant aneurysms were clipped successfully under muti-technology, follow-up demonstrated excellent neurological outcomes in 15 cases, one case had mild disability, one case had severe disability, no dead cases. DSA showed clipping completely, parent artery clear, and long-term follow-up was still in progress.Conclusion Multi-technology combined microsurgical techniques which can effective improve the outcomes of intracranial giant aneurysms.