Objective To explore the effective therapeutic methods for hepatolithiasis.Methods We retrospectively analyzed the clinical material of 178 hepatolithiasis patients who underwent surgical therapy.Among the 178 patients,107 patients were treated with T-tube drainage(including 7 patients with left hepatic lobe or quadlrate lobe resection),and 71 patients were treated with bile duct-intestinal anastomosis(including 11 patients with left hepatic lobe or quadrate lobe resection).Results Recurrence rate of postoperative angiocholitis in the two groups was 49.5 % and 24 % respectively,and the reoperation rate was 28.7 % and 8 % respectively.Conclusions The key to prevent recurrent angiocholitis and reduce the reoperation rate is to relieve biliary tract stricture,remove the focus of infection and provide unobstructed bile duct drainage.

Objective To observe the coronary vessel lumen diameter and bifurcation angle in subjects with normal CT coronary angiography (CTCA) imaging.Methods64-row CT coronary angiography imaging from 526 adult people with excellent image quality and normal vascular image were analyzed in this study.The lumen diameter from the origin to distal with 2 mm lumen of left main coronary artery (LM),anterior descending branch (LAD),left circumflex branch (LCX) and right coronary artery (RCA) was measured at 1 cm interval in CPR image.The vascular tapered ratio was calculated.The bifurcation angle in the diagonal branch,obtuse marginal branch,posterior descending branch,acute marginal branch as well as the origin diameter was also measured in VR image.Results The LAD average length was 13 cm and lumen diameter was 3.92 mm at origin and 2.10 mm at distal.The average decremented ratio of LAD was 7.7％ ( male 7.0％,female 8.4％ ).The maximal decremented ratio 8.0％ -10.0％ occurred at 3 -5 cm apart from the origin of LAD.The LCX average length was 13 cm and lumen diameter was 3.57 mm at origin and 2.10 mm at distal.The average decremented ratio of LCX was 9.7％( male 9.6％,female 9.7％ ).Lumen decremented ratio was less than 3.0％ between origin and proximal 3 cm and 8.3％ - 10.7％ in the rest portion of the LCX.The RCA average length was 18 cm and lumen diameter was 3.97 mm at origin and 2.15 mm at distal.The average decremented ratio of RCA was 5.1％(male 4.9％,female 5.3％ ).The decremented ratio of RCR was less than 4.0％ between origin and proximal 10 cm and 6.1％ - 15.2％ in the rest portion.The bifurcation angle was 50,55,66 and 76 degree for LAD with diagonal branch,LCX with obtuse marginal branch,RCA with posterior descending branch and RCA with obtuse marginal branch respectively.Conclusion Coronary artery length,lumen diameter and decremented ratio as well as bifurcation angel could be identified in 64 row CTCA image in vivo.This information could help us to understand the in vivo coronary artery anatomy.

Objective To investigate the importance of nursing cooperation in the operation of middle cerebral artery aneurysm ( MCAA) microsurgical clipping. Methods We retrospectively analyzed 202 cases ( male 103 cases, female 99 cases) of MCAA patients who were underwent microsurgical clipping surgery ( from January 1997 to December 2013), and the importance of nursing cooperation in the process were analyzed. A total of 242 aneurysms were found during surgery of 212 cases underwent craniotomy clipping, in which 215 cases were MCAA, and 2 cases underwent autologous dura wrapping, except one unbroken MCAA case was embolism. Results All patients in this group underwent Yasargil′s pterional trans-sylvian approach, 212 MCAA surgery were successfully clipped. 174 cases were clipped without rupture (81. 3%), while rupture (18. 7%) occurred in 40 patients during surgery. All patients had been treated with controlled hypotension and intracranial hypotension, through timely blood transfusion, infusion and other response measures to ensure the successful completion of surgery. Conclusions It can help will the operation completed smoothly and improve surgical effects by personalized utilizing of controlled hypotension, brain tissue relaxation techniques and other measures in microsurgical clipping of MCAA, as well as good nursing cooperation during the process of aneurysms rupture.

BACKGROUNDThere are few studies on the clinical profile of Chinese patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). The purpose of this study was to describe the clinical characteristics of ARVD/C patients from China, particularly to define the features of electrocardiograph and treatment outcomes.

METHODSThirty-nine patients hospitalized in Fu Wai Cardiovascular Hospital from 1998 to 2006 were included. The data were obtained from the medical archive and the follow-up records.

RESULTSOf these patients 33 were male and 6 female (age at the first presentation was (34.9 +/- 9.8) years). The most common symptoms were palpitation (62%) and syncope (44%). Right precordial QRSd >or= 110 ms was detected in 69% of the patients, epsilon wave in 59%, and a ratio of QRSd in V(1) + V(2) + V(3)/V(4) + V(5) + V(6) >or= 1.2 in 82%. The most frequent features of electrocardiogram in patients without right bundle-branch block were T-wave inversions and S-wave upstroke in V(1)-V(3) >or= 55 ms (96% and 90% of 28 patients, respectively). Radiofrequency catheter ablation (RFCA) for ventricular tachycardia (VT) was successful in 15 (68%) of 22 patients. The recurrence rate of VT was 46% (7/15) during the follow-up of (16.7 +/- 11.2) months. Seven patients had cardioverter/defibrillator (ICD) implanted plus drug therapy and 17 patients took antiarrhythmic drugs alone. During the follow-up of (35.6 +/- 19.0) months, all patients with ICD implanted received at least one appropriate ICD shock. One patient died of ventricular fibrillation suddenly and one patient underwent heart transplantation for progressive biventricular heart failure during the drug therapy alone.

CONCLUSIONSThis study demonstrated the clinical and ECG features of the 39 ARVD/C Chinese patients. ICD provided life-saving protection by effectively terminating malignant arrhythmias, and the high recurrence of VT was the major problem of RFCA therapy.

Adolescent ; Adult ; Anti-Arrhythmia Agents ; therapeutic use ; Arrhythmogenic Right Ventricular Dysplasia ; diagnosis ; drug therapy ; physiopathology ; therapy ; Catheter Ablation ; Defibrillators, Implantable ; Electrocardiography ; Female ; Heart Transplantation ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Young Adult

OBJECTIVEStudies have shown that potassium channel plays a pivotal role in T cell activation. The expression of potassium channel gene KCTD9 was evidenced being highly upregulated in patients with severe hepatitis B (SHB). To understand this phenomenon further, tissue and cellular expression profiles of KCTD9 were investigated in patients with SHB.

METHODSA rabbit peptide polyclonal antibody was prepared. Various samples including peripheral blood mononuclear cells (PBMCs); livers from patients with SHB or mild chronic hepatitis B, were examined for KCTD9 expression by quantitative real time PCR and immunohistochemistry staining (IHC). Confocal microscopy was used to illustrate the localizations of the expressions.

RESULTSIncreased expression of KCTD9 was observed in PBMC in over 35.7% of the patients with SHB when compared with that of patients with mild chronic hepatitis B. In all patients, the relative value of increased KCTD9 mRNA was positively correlated with alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin but negatively with serum albumin. The expression was mainly located in hepatocytes, bile duct epithelial cells, Kupffer cells and inflammatory cells, and in the cytoplasm of PBMCs from the healthy individuals and patients with mild chronic hepatitis B, whereas in both cytoplasm and nuclei in those from patients with SHB.

CONCLUSIONThe increased expression of potassium channel gene KCTD9 correlates with disease severity in patients with viral hepatitis B.

Adult ; Female ; Hepatitis B, Chronic ; blood ; virology ; Humans ; Male ; Middle Aged ; Monocytes ; metabolism ; Potassium Channels ; genetics ; metabolism ; RNA, Messenger ; genetics ; Young Adult

OBJECTIVETo retrospectively analyze the clinical and electrocardiographic features of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).

METHODSThe clinical, electrocardiographic features and the efficacy of various therapies were analyzed in 31 patients (27 males) diagnosed as ARVC according to the criteria established by European Society of Cardiology.

RESULTSThe averaged age when the ARVC was first diagnosed was (34.7 +/- 9.4) years (19 - 58 years), palpitation was present in 28 patients (90.3%) and syncope in 13 patients (41.9%), a family history of sudden death was present in 1 patient. Dilatated right ventricle was documented in 29 patients by echocardiography and (or) magnetic resonance imaging (MRI), 2 of them with dilated left ventricles. ECG changes included: T wave inversion, mostly seen in precordial leads (100%); epsilon (epsilon) wave (54.8%); QRS duration >or= 110 ms in V(1) to V(3) (83.9%); reduced extremity amplitude (41.9%); the first degree of AV block (22.6%); sustained VT (100%) including 15 monomorphic VT (48.4%) and 16 polymorphic VT (51.6%). The mean values of QRS duration in leads of V(1 - 3) [(120.8 +/- 13.7) ms] was significantly longer than that in V(4 - 6) [(99.4 +/- 13.7) ms, P < 0.05]. Fourteen patients underwent radiofrequency catheter ablation (RFCA) with an immediate success rate of 78.6% (11/14). During follow up (18.3 +/- 10.2) months, VT reoccurred in 6 patients (54.5%). The remaining 17 patients were treated with conventional medications, 7 of them were medicated under implanted cardioverter defibrillator (ICD). During the follow-up (35.6 +/- 19.0) months, VT reoccurred in 11 patients (64.7%) and one patient died suddenly.

CONCLUSIONSARVC patients developed symptoms at mid-30s with significant ECG changes including appearance of an epsilon wave, T wave inversion and QRS duration >or= 110 ms in leads of V(1 - 3). The long term therapy efficacy was not satisfactory both for RFCA and conventional medications and ICD implantation should be recommended to patients with ARVC.

Adult ; Arrhythmogenic Right Ventricular Dysplasia ; diagnosis ; therapy ; Catheter Ablation ; Defibrillators, Implantable ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult