Objective To evaluate the effect of homemade tirofiban in percutaneous coronary intervention for acute myocardial infarction. Methods Sixty four cases of consecutive acute myocardial infarction were enrolled and divided into two groups: the tirofiban group (n=34) and the control group (n=30). In addition to intravenous heparin, patients in the tirofiban group received a bolus dose of tirofiban (10 ?g/kg) before stenting and followed by a 0.15 ?g/(kg?min) infusion for up to 12-36 hours. The control group only receive routine intravenous heparin therapy before and during PCI. The post operation TIMI blood flow, bleeding events and major adverse cardiac events were observed in the 2 groups. Results A 97.1% of patients in the tirofiban group compared with 76.7% in the control group obtained TIMI grade 2-3 flow respectively. Among them, 91.2% in the tirofiban group but 70.0% in the control obtained TIMI 3 flow. There were no serious in-hospital bleeding complications and MACE. Conclusion Homemade tirofiban is effective in improving the TIMI grade and prognosis of acute myocardial infarction after PCI.

Objective To observe the effects of swimming in cold water on the functioning and structure of the peripheral nerves of diabetic rats,and to compare the effects of seawater and fresh water. Methods Forty SD rats weighing ( 250 ± 20) g were randomly divided into a normal control group (A),a diabetic model group ( B ),a seawater swimming group (C) and a fresh water swimming group (D) with 10 rats in each group.The swimming training was carried on 5 times a week for 8 weeks.At the end of the 4th and 8th week of training,caudal nerve conduction velocity (CNCV) was measured.The nerve structure of the caudal nerves was observed at the end of the 8th week. Results By the 4th week,CNCV had slowed significantly in group B compared with group A,but not in groups C and group D.Compared with group B,CNCV had increased significantly in group C.There was no significant difference in CNCV between groups C and D.At the 8th week,compared with group A,CNCV had slowed in groups B and C.Compared with group B,CNCV was significantly faster in groups C and D.However,there was no significant difference between group C and group D with regard to CNCV.At the end of the 8th week demyelination was observed in the caudal nerves under a light microscope and an electron microscope in groups B,C and D,but the demyelination was milder in groups D and C. Conclusion Swimming in cold water can prevent or delay diabetic neuropathy in diabetic rats.There was no significant difference between seawater and fresh water swimming in terms of its effect on CNCV.

Objective To investigate the effect of acupuncture combined with minimally invasive hematoma aspiration on a rabbit model of brain injury in the acute stage of intracerebral hemorrhage (ICH). Methods A total of 65 healthy New Zealand white rabbits were randomly divided into a sham operation (SO) group, an ICH group,a hematoma aspiration (HA) group, and an acupuncture and hematoma aspiration (AHA) group. Models of ICH were established in the latter three groups. The HA group was treated with minimally invasive hematoma aspiration and the AHA group was treated with both acupuncture and minimally invasive hematoma aspiration. At 6 hours and 1, 3 and 7 days after the ICH models were established, brain water content (BWC) was measured, and the expression of matrix metalloproteinase-9 ( MMP-9 ) in the rabbits' brains was detected by immunohistochemistry. MMP-9activity was detected by gelatin zymography. Results The BWCs of the ICH group, HA group and AHA group rabbits were significantly higher than those of the SO group. The BWCs of the HA group and AHA group animals descended significantly more than those in the ICH group as time went on, especially on the 3rd day in the AHA group. Immunohistochemistry and gelatin zymography showed that the expression and activity of MMP-9 in these test groups decreased with time, especially on the 3rd day in the AHA group. Conclusions Acupuncture combined with hematoma aspiration can reduce injury in the acute stage of ICH, and inhibition of the expression of MMP-9 may be the mechanism.

Objective: To construct subtracted cDNA libraries of stomach tumors and normal stomach tissue using suppression subtractive hybridization(SSH).Methods: cDNA Library subtraction was performed using the protocol described in the Clontech PCR-Select cDNA Subtraction Kit. cDNA was synthesized from 2 μg of poly A+RNA from the tumor and normal tissues using AMV reverse transcriptase. The tester and driver cDNAs were digested with RsaⅠ, a four-base-cutting restriction enzyme that yields blunt ends. The tester cDNA was then subdivided into two portions, and each was ligated with different cDNA adaptor. Two hybridizations were performed. In the first, an excess of driver was added to each sample of tester. Hybridization kinetics led to equalization and enrichment of differentially expressed sequences. During the second hybridization, the two primary hybridization samples were mixed together without denaturing and thus the templates were generated from differentially expressed sequences for PCR amplification. Using suppression PCR, only differentially expressed sequences were amplified exponentially and after second PCR amplification the background was reduced and differentially expressed sequences were further enriched. The cDNAs were then directly inserted into a T/A cloning vector to generate a stomach tumor-specific subtracted cDNA library. Results: The amplified library contained 800 positive clones. Plasmid inserts were PCR amplified and showed 250－700 bp inserts. Conclusions: The successfully constructed subtracted cDNA library of gastrocarcinoma and normal tissue enables us to compare two populations of mRNA and obtain clones of genes that expressed in one population but not in the other.The characterization of these genes will allow them to be exploited for their diagnostic and therapeutic potentials.

Objective To summarize the echocardiographic characteristics and clinical signiifcance of prenatal diagnosis of coronary artery ifstula (CAF). Methods Images and follow-up results of ifve fetuses with CAF diagnosed by fetal echocardiography between January, 2011 and December, 2012 in our department were reviewed. Results Echocardiographic characteristics of CAF were a dilated coronary artery in the four chamber view and the left ventricular outlfow tract view. Track the course of the dilated coronary artery can conifrm the oriifce of the ifstula. Among the ifve cases, the oriifce of the ifstula included the aortic root of left ventricular outlfow tract, right atrium side of interatrial septum, the entrance of superior vena cava to right atrium, right ventricular apex and right ventricle cone. The colour Doppler lfow imaging showed turbulence in the dilated coronary artery. The spectral Doppler with the sampling gate in coronary artery showed the characteristic bidirectional lfow pattern. One case was associated with other complex intracardiac abnormalities and one case with persistent left superior vena cava. Among the ifve cases of CAF diagnosed by fetal echocardiography, one case was missed and four cases were conifrmed by postnatal echocardiography. Conclusion Coronary artery ifstula has special fetal echocardiographic characteristics. The fetal echocardiography plays an important role in early detection, diagnosis and treatment of CAF.

BACKGROUND: Inflammatory and proliferating effect after mechanical injury of vascular wall is the major cause of restenosis. Nuclear factor-kappa B (NF-κB) in the NF-κB/Rel family is expressed in a variety of cell types and activates a series of target genes, which are related to the pathophysioiogy of vascular wall.OBJECTIVE: To investigate the effect of antisense and decoy NF-κB oligonucleotides on vascular smooth muscle cell (VSMS) proliferation in vitro and neointimal proliferation and monocyte chemotactic protein-1 (MCP-1) in the balloon-injured carotid artery of rats.DESTGN: Randomized controlled animal trial.SETTTNG: Department of Cardiology, Ruijin Hospital, Medical College, Shanghai Jiaotong University.MATERTALS: Totally 126 male Sprague-Dawley (SD) rats, aged 3 months, weighing 350 to 380 g, were involved in this study. Synthesis of primer and oligonucleotide: they were synthesized and designed by Shanghai Bioengineering Co. Ltd according to literatures and international internet cDNA library.METHODS: This study was carried out in the Laboratory of Cell Biology, Medical College, Shanghai Jiao Tong University and Cardiovascular Laboratory, Ruijin Hospital Affiliated to Shanghai Jiaotong University from May 2001 to March 2003.Rat aortic smooth muscle cells were isolated from May 2001 to March 2003. Rat thoracic aorta vascular smooth muscle cells were cultured by primary-explant method. And the third to fifth generations of VSMCs were involved in the experiment. Proliferating cell nuclear antigen (PCNA) NF-κB p65 protein synthesis in proliferating smooth muscle cells were detected. SD rat carotid artery underwent balloon injury. The involved 126 rats were randomly divided into 7 groups with 18in each group: normal group: normal group (the procedure was the same as other group except for balloon injury), sense group, antisense group, decoy group, scramble group, antisense plus decoy group, model group. Each group includes 6time points (6 hours, and 1,3,5,7,14 days, n =3). Then, the effect of antisense and decoy NF-κB oligonucleotides on intimai proliferation and MCP-1 and NF-κB p65 and extracellular signal regulated kinase(ERK2) expression in the balloon-injured carotid artery of rats were detected.MAIN OUTCOME MEASURES: ①Effect of oligonucleotide of NF-κB p65 on VSMCs proliferation; ② NF-κB p65 gene expression and protein synthesis; ③ Patho-morphological change after carotid balloon-injury. ④ Vascular MCP-1 mRNA Expression in balloon-injured rat carotid artery; ⑤ MCP-1 immunoreactivity in the injured arterial wall detected by immunohistochemistry; ⑥ NF-κBp65 and ERK2 protein synthesis after balloon-injury detected by Western blot in injured rat carotid arteries.RESULTS: ①PCNA protein synthesis increased in proliferating smooth muscle cells. ②NF-κB p65 gene expression was found in the cytoplasm and nucleus of proliferating smooth musclecells by in situ hybridization and NF-κB p 65 protein level increased in proliferating smooth muscle cells by flow cytometry. NF-κB p65 gene expression in antisense group decreased 53.66% compared with in sense group; it decreased 57.35% in decoy group compared with in scramble group. There were all statistical differences(P＜0.05).③ PCNA expression were inhibited in proliferating smooth musclecells by antisense and decoy oligonucleotides. Compared with positive control group, PCNA protein expression in antisense group and decoy group decreased 45.12% and 45.05%,respectively. ④ In model group, sense group and scramble group, vessel intimal area, medial area and intimal area/medial area increased at the 5th day after balloon-injury and reached the maximum at the 7th day after injury. The intimal area/medial area was significantly decreased in the antisense group and decoy group. The effect of antisense plus decoy oligonucleotides was more obvious than that of antisense group and decoy group alone but there were not significant differences among three groups. ⑤ Reverse transcription-polymerase chain reaction showed that MCP-1 mRNA expression was significantly increased 6 hours after balloon-injury, but not evident after 1 day. It was increased at the 3th, 5th and 7th days continuously, but decreased at the 14th day. MCP-1 mRNA expression was decreased at each time point in antisense group, decoy group, antisense plus decoy group (P＜0.05). ⑥Western blot analysis showed that NF-κB p65 was weakly expressed at 6 hours after vascular balloon-injury, increased significantly at 1 day, reached the peak at 7 days and weakened at 14 days, while ERK2 protein was weakly expressed, a little increased at 1 day, reached the peak at 7 days and weakened at 14 days. Treatment of antisense group, decoy group and antisense plus decoy group inhibited protein synthesis more significantly than those of model group, sense group and scramble group (P＜0.05).CONCLUSTON: NF-κB expression increases in proliferating smooth muscle cells. NF-κB modulates genes expression and protein synthesis of MCP-1 and ERK2. Cellular proliferation in vessel wall dynamically changes after balloon angioplasty injury. Antisense and decoy oligonucleotide of NF-κB by local lipofectamine transfer inhibit the expression of regulated target gene.

Objective To study the applications and outcomes of using autogeneic cartilage in hearing recon-struction surgery in patients with chronic otitis media or cholesteatoma .Methods A total of 165 patients (173 ears) in whom autogeneic cartilage was used were analyzed retrospectively .Forty -three patients (48 ears) had simple tympanic membrane perforations ,61 patients (61 ears) had cholesteatomas including 12 retraction pockets ,23 pa-tients (23 ears) had tympanoscleroses and 38 patients (41 ears) had otitis media with granulations .The cartilage grafts were used for tympanic perforation reparing in 133 patients (139 ears) ,for ossiculoplasty in 102 patients (104 ears) ,for attic reconstruction in 31 patients (31 ears) and for canal wall reconstruction of external auditory canal in 3 patients (3 ears) .The auditory outcome (0 .5 ,1 ,2 ,and 4 kHz pure tone average hearing threshold ,the average air-bone gap) and local architecture status were followed up for 1 year after surgery .Results In 133 patients (139 ears) with tympanic perforation ,the rate of successful repair of a tympanic membrame perforation in one -stage was 97 .84% with perforation repair in 136 ears and postoperative perforation in 3 ears .In 102 patients (104 ears) of os-siculoplasty ,there was no ossicular prostheses prolapse .In 31 patients (31 ears) of attic reconstruction ,no local graft shift or collapse was found .In 3 patients (3 ears) of external auditory canal repair ,no canal wall collapse occurred . In myringoplasty group (43 patients ,48 ears) ,preoperative and postoperative air -bone gap (ABG) was 23 .8 ± 3 .1 dB and 11 .6 ± 8 .7 dB ,respectively .In cholesteatoma group (61 patients ,61 ears ) ,preoperative and postoperative ABG were 39 .2 ± 24 .7 dB and 19 .0 ± 12 .1 dB ,respectively .In tympanosclerosis group (23 patients ,23 ears) ,pre-operative and postoperative ABG were 31 .2 ± 12 .4 dB and 19 .8 ± 11 .2 dB ,respectively .In otitis media with granu-lation group (38 patients ,41 ears) ,preoperative and postoperative ABG were 41 .6 ± 9 .9 dB and 15 .3 ± 13 .4 dB ,re-spectively .Conclusion Autogeneic cartilage is very valuable in hearing reconstruction surgery ,especially in compli-cated tympanic perforation ,combination with ossiculoplasty prostheses ,or reconstruction of mastoid cavity or exter-nal call wall defect .

OBJECTIVE To explore the effect of E-cadherin on the proliferation ability of Hep-2 by method of RNA interference technology to silence the expression of E-cadherin. METHODS The specific siRNA sequences and non-silencing siRNA were designed and synthesized. Hep-2 cells were transfected and then the down expression of E-cadherin gene in vitro cultured Hep-2 cells were got. The silencing effect of E-cadherin gene was explored by Fluorescence Quantitative Polymerase Chain Reaction and the proliferation of the transfected Hep-2 cells were detected in vitro by MTT assay. RESULTS 1.When transfected with the ratio of recombinant plasmid and the quality of liposome volume at 1:1, the transfection efficiency at the siRNA-3 group was the highest and can be up to 65%. 2.The results of Fluorescence Quantitative Polymerase Chain Reaction: recombinant plasmid pRNAT-U6.1/Neo-siRNA1, pRNAT-U6.1/Neo-siRNA2 and pRNAT-U6.1/Neo-siRNA3 can down regulate the expression of E-cadherin mRAN. Set blank control group as a baseline (set to 1), the changes of expression of E-cadherin relative to β-actin in siRNA-1group was 0.00092, siRNA-2 group was 0.00143, siRNA-3 group was 0.00045 and the negative control group was 3.44898. The difference was statistically significant (P<0.05). 3. MTT: The growth rate of Hep-2 cells treated by specific siRNA was faster than that of the control group, and the difference was statistically significant (P<0.05). CONCLUSION Effectively inhibition the expression of E-cadherin's mRAN can enhance the proliferation of Hep-2 cells.

With wide application of medical consumables, inventory management of medical consumables has important significance. The principle and two specific methods for keeping inventory level are introduced to give specific requirements of stock materials keeping and quality management. How to set up scientific management processes is more discussed in order to protect the work development of clinical medical care in health and safety in related crow, such as patient and user, and improve the efficiency and reduce labor intensity of care, so that the quality of medical care can reach to a new level.

Objective:To evaluate the clinical advantage and disadvantage of anatomical landmark registration(ALR) and surface registration(SR) in computer-assisted endoscopic sinus surgery(CAESS).Method:Twenty-six patients were selected for the CAESS, the preparatory times and mean target registration errors (TRE) were recorded in order to compare the difference between them two, their convenience and their value were also analyzed.Result:CAESSs were successfully used in 26 cases without complications. The average preparation time of SR was(8.5±1.9)minutes, that of ALR was(6.5±1.7)minutes. In the SR group, the TRE of naso-labial angle was(1.43±0.26)mm, that of front end of middle turbinate was(1.92±0.47)mm, that of front end of inferior turbinate was (1.82±0.49)mm, and that of back end of inferior turbinate was (2.03±0.42)mm. Them in ALR group were (1.58±0.35)mm,(2.05±0.37)mm,(1.92±0.31)mm and (2.48±0.64)mm ,respectively.24 cases (92.2%) were not affected or were slightly affected by the navigation system. The value of navigation was affirmative in 22 cases (84.6%), and its value was mainly related to TRE.Conclusion:The accuracy of surface registration was superior to that of anatomical landmark registration, but the anatomical landmark registration was more convenient and need less preparation time. The value of navigation system is its accuracy, convenience and no disturbance to surgery. The navigation system is more valuable in the complex cases than that in the general case.