ObjectiveTo observe the effect of Tongxinfang on coronary collateral formation and stent-restenosis in patients with coronary artery disease after stenting.Methods61 patients with coronary artery disease were randomly divided into the treatment group (n=30), and control group (n=31). Patients of the treatment group were taking Chinese medicine Tongxinfang for six months, but cases of the control group only received basic treatment. Coronary collateral formation, stent-restenosis and ejection fraction (EF) of patients of two groups were assessed through aniograms and echocardiography before treatment and after six months.ResultsCoronary collateral formation and EF of patients of the treatment group improved significantly compared with cases of the control group (P<0.01 or P<0.05), but the minimal lumen diameter and percent of diamter stenosis were not significantly different between two groups (P>0.05).ConclusionTongxinfang can improve coronary collateral formation and EF.

ObjectiveTo observe the effect of Yiqihuoxue recipe on left ventricular remodeling after acute myocardial infarction (AMI).Methods40 patients with AMI were randomly divided into treatment group and control group with 20 cases in each group and received Yiqihuoxue recipe or fasinopril respectively for 6 months. Changes of clinical symptoms, the level of plasma angiotensin Ⅱ(ATⅡ), aldosterone (ALD), endothelin (ET) and echocardiographical indexes: left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), ejection fraction (EF), left ventricular mass index (LvmassI), wall motion index (WMI), wall thick (WT), E/A were assessed before discharge, and in the end of 3rd and 6th month after AMI.ResultsClinical symptoms of patients of treatment group improved significantly (P<0.01). EF and E/A of all patients in two groups increased (P<0.01 or P<0.05), LvmassI and WT reduced (P<0.05), but there were no significantly differences between two groups in LVEDVI, LVESVI, EF, LvmassI, WMI, E/A and WT(P>0.05). The level of plasma ET decreased in treatment group (P<0.05), the level of plasma ATⅡ and ALD of control group decreased more than that of treatment group (P<0.05).ConclusionYiqihuoxue recipe can significantly improve clinical symptoms, cardic function, and left ventricular remodeling, showing a better clinical efficacy.

ObjectiveTo investigate the feasibility,technique and clinical effect of applying laparoscopic plastic surgery in the treatment of horseshoe kidney.Methods Eleven patients with horseshoe kidney were admitted from Mar.2006 to Mar.2011.There were 5 males and 6 females with mean age of 27years (14 to 46 years).Clinical manifestations included lower-back pain in 8 cases,lower-back pain and hematuria in 2 cases,lower-back pain and fever in 1 case.There were 6 cases accompanied with kidney calculi.All the cases with calculus were in left kidney and there was 1 case with multiple calculi.There were 11 cases accompanied with left hydronephrosis.Of which,there were moderate hydronephrosis in 6 cases,severe hydronephrosis in 5 cases.There were 3 cases accompanied with mild right hydronephrosis.There were 2 patients with renal insufficiency,1 patient with urinary tract infection.The surgery procedures included laparoscopic isthmectomy and plastic surgery in 3 cases,isthmectomy and plastic surgery and pelviolithotomy in 6 cases,isthmectomy and vascular compression release in 2 cases.ResultsAll patients had successful surgeries with the mean operative time of 145 min (95 - 190 min).The average blood loss was 250 ml ( 100 -400 ml).Average postoperative hospital stay was 10 d (7 - 15 d).One patient suffered from urinary leakage after surgery and recovered after anti-inflammatory therapy and local drainage.One patient suffered from secondary hemorrhage controlled with DSA.All the patients were followed up with a mean of 17 months (6 -28 months).In 6 cases with moderate hydronephrosis,5 patients recovered to mild hydronephrosis and 1 case improved from preoperative renal hydronephrosis 3.5 cm to postoperative 3.0 cm.In 5 cases with severe hydronephrosis,3 patients improved to moderate hydronephrosis,2 patients to mild hydronephrosis.One patient with kidney stone had 0.4 cm residual stone.Three patients complained of occasional mild backache.One patient suffered from hematuria and urinary tract infection,recovered after antiinflammatory therapy for 2 weeks.The remaining 6 patients were in good conditions during the follow-up.ConclusionTransperitoneal laparoscopic plastic surgery is able to deal with horseshoe kidney isthmus malformation and comorbidities,and is another alternative for the treatment of horseshoe kidney.

Objective To summarize the causes and treatment strategies for laparoscopic vascular injuries.Methods We had retrospectively reviewed 1858 cases of laparoscopic surgeries from March 2006 to February 2011.There were 10 cases (6 males and 4 females) had intraoperative vascular injuries.The mean age of these 10 patients was 49 years (ranged from 21 to 78 years).2 cases were aortic injuries,2 cases were vena cava injuries,4 cases were renal vein injuries,1 case was iliac vein injury and 1 case was iliac artery injury.The causes of vascular injuries included 2 cases caused by lack of anatomical understanding; 1 cases occurred during establishment of the first puncture site ; 2 cases caused by forced operation during the procedure; 2 cases caused due to ectopic anatomy; 3 cases caused due to adhesions and difficulties in dissection.Treatment strategies were maintaining pneumoperitoneum pressure and rapidly increasing the pressure to 2.6Kpa if a large amount of bleeding in a short time.With the help of suction,the bleeding sites could be identified.If necessary,an additional trocar was added to help exposure.The bleeding was closed with 4-0 vessel sutures.For arterial bleeding,the upper and lower ends of blood vessel ruptures were clipped with bulldog clamp,then follow the same procedures of variceal bleeding sutures if the bleeding were controlled.Results In 7 of the 10 cases,the bleedings were successfully controlled by laparoscopic technique,while the other 3 were converted to open surgery for bleeding control.The average laparoscopic hemostasis time in the 7 cases was 14 min (range from 8 to 25 min),the average blood loss was 530 ml (range from 150 to 1600 ml).Rupture size were 0.2-1.0 cm.One aortic injury case had complication of big post operative local hematoma which was spontaneously absorbed 3 months after surgery.And the other 9 patients did not have air embolism,hemorrhage and other complications.Conclusions Laparoscopic vascular injuries can be caused by a variety of causes.The strategies of controlling the bleeding are calmness and the fine suturing to control bleeding.A skillful assistant also plays an important role in dealing with this complication.

Objective To report the surgical methods and results of pure laparoscopic radical cystectomy with orthotopic U-shape ileal neobladder.Methods From August 2010 to April 2014,19 patients with locally advanced bladder cancer (cT2-3 N0-2 M0) underwent pure laparoscopic radical cystectomy and Endo-GIA assisted orthotopic U-shape ileal neobladder reconstruction.Perioperative and follow-up data were collected.Results The surgeries were successful in all 19 cases with the operating time ranging from 261 to 380 min,blood loss of 100 to 350 ml.Postoperative hospital stay was 21±4 (15-26) days,postoperative intestinal function recovery time at 1.9±0.4 (1.5-2.3) days.Surgical margins were all negative.Lymph node positive rate was 32％ (6/19).Complications were including 1 case of lymphatic leakage; 3 cases of new bladder and urethra anastomotic fistula.There were 17 cases of urinary incontinence,all these cases were improved after 3 months,but there were still 8 cases of night-time incontinence.Three cases had unilateral ureteral reflux,ureter mild hydrocephalus,1 of the cases had recurrent infections within 1 month after surgery.After the anti-inflammatory and catheterization treatment,the symptoms were improved.Two cases had unilateral ureteral anastomotic stricture,one underwent percutaneous nephrostomy and cystoscope-assisted double J tube placement,another underwent laparoscopic ureteral neobladder reimplantation.One case had bilateral ureteral stenosis due to recurrent infections,and underwent bilateral laparoscopic ureteral-new bladder reimplantation.Patients were followed up for 8-42 months,no recurrence or distant metastasis was found.Conclusion Pure laparoscopic radical cystectomy with endo-GIA assisted orthotopic U-shape ileal neobladder can reduce surgical trauma and help patient's postoperative recovery.

Objective To investigate the expression of Twist,E-cadherin and N-cadherin in bladder urothelial carcinoma and evaluate their relationships with tumor.Methods From January 1998 to June 2007,the expression of Twist,E-cadherin and N-cadherin protein were detected in 180 bladder urothelial carcinoma tissue specimens in paraffin blocks and 60 normal bladder tissue specimens by tissue microarray and immunohistochemistry.Results Compared with normal hladder tissues,the expression of Twist and N-cadherin was up-regulated in bladder carcinoma tissues and the positive percentage was 63.9％ and 47.8％ respectively.The percentage of high E-cadherin expression in bladder carcinoma tissues was only 27.8％,which was significantly lower than that in normal bladder tissues.The expression of Twist was significantly related with age,tumor number,vessel invasion,distant metastasis and lymph node metastasis (P＜0.05).The expression of E-cadherin was significantly related with distant metastasis and lymph node metastasis (P＜ 0.05).The expression of N-cadherin was significantly related with distant metastasis and lymphnode metastasis (P＜0.05).There was significant positive correlation between Twist and E-cadherin expression (P＜ 0.05).There was significant positive correlation between Twist anl N-cadherin expression (P＜0.05).There was negative correlation between E-cadherin and N-cadherin expression.All the 180 bladder carcinoma patients were followed up after the surgery,and the mean follow-up time was (35.2±9.1) months.The 5-year survival rates of patients with low and high Twist expressions were 67.7％ and 46.1％ respectively,and there was significant difference between the two groups (P＜0.05).The multivariate analysis indicated that the Twist expression was an independent prognostic factor of bladder carcinoma.Conclusions The high expression of Twist,E-cadherin and N-cadherin are involved in the processes of invasion and metastasis of bladder urothelial carcinoma.The Twist expression was one of the independent prognostic factors of bladder urothelial carcinoma.

OBJECTIVE: To investigate the expression of hyperpolarization-activated cyclic nucleotide-gated cation channel 4 (HCN4) and connexin43 (Cx43) in the sinoatrial node of electric shock death. METHODS: As experimental group, 34 cases of electric shock death who had definite current mark evidence were selected from pathology department of Xuzhou Medical College from 2010 to 2013. As the control group, 20 cases of fatal severe craniocerebral injury in traffic accidents were chosen. The expressions of HCN4 and Cx43 in the sinoatrial node were observed by immunohistochemical technology. RESULTS: HCN4 positive cells expressed in the cell membrane and cytoplasm of the sinoatrial node. Cx43 positive cells expressed in the cell membrane and cytoplasm of T cells and myocardial cells. The expression of HCN4 was significantly higher than that of the control group (P < 0.05) and the expression of Cx43 was significantly lower than that of the control group (P < 0.05). CONCLUSION The changes of HCN4 and Cx43 expressions in the sinoatrial node illustrate electric shock death might be related to the abnormalities of cardiac electrophysiology and conduction.
Connexin 43/metabolism* ; Cyclic Nucleotide-Gated Cation Channels ; Heart Rate ; Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels/metabolism* ; Immunohistochemistry/methods* ; Myocardium/metabolism* ; Myocytes, Cardiac ; Sinoatrial Node/physiopathology*

Objective To evaluate the feasibility and efficacy of laparoscopic repair of vesicovaginal fistula (VVF) with omentum shift.Methods Sixteen VVF patients were reviewed retrospectively from July 2007 to July 2011,aged from 34 to 72 years with a mean age of 48 years.The history of leakage of urine ranged from 1 month to 30 years,of which 15 cases due to uterine operation complication and 1 case due to IUD perforation.All cases were single fistula,with the fistula diameter ＜ 1 cm in 13 cases and ＞ 1 cm in 3 cases.Fourteen cases of fistulas were in the vaginal wall,and 2 cases were in the cervix.Surgical techniques were transabdominal laparoscopic local displacement of the great omentum and conventional layered suture repair of vesicovaginal fistula.Results All surgeries were successful.The operation time was 120 -175 min,with an average of 150 min.The blood loss was 50 -300 ml,with an average of 120 ml.The postoperative hospital stay was 6 to 10 d,with an average of 8.5 d.The catheter indwelling time was 14 to 21 d,with an average of 17 d.During the period of follow-up for 3 to 45 months with an average of 23months,14 cases cured,1 case improved and 1 case failed.No major complications such as intestinal injury occurred.Conclusions Laparoscopic repair of VVF with great omentum shift has the characteristics of less damage,less pain and positive effect.The key points of the surgery are local filling of great omentum and delicate layered suture.

Objective To understand the prevalence of hypertension and diabetes and its associated factors among rural resi-dents in Chongqing ,in order to provide the evidence for conducting non-communicable disease prevention and control in rural area . Methods Rural residents aged above 18 years old were sampled by multi-stage stratified random sampling .The resident sampled was interviewed with the structured questionnaire by face-to-face and examined body weight ,height ,blood pressure ,waist circum-ference .The blood sample was taken to test fasting glucose ,2 h glucose .The associated factors of hypertension and diabetes were i-dentified by Chi-square test and the independent factors of hypertension and diabetes were identified by Logistic regression .Results A total of 2 406 rural residents were interviewed .The amount of salt in taking and oil in taking per person per day self-reported was 6 .7 g and 44 .4 g .The proportion of smoking among rural residents was 21 .0% .The proportion of alcohol use in the past 12 months was 22 .4% .32 .6% of interviewees participated in the regular physical activity .The proportion of overweight and obesity a-mong rural residents was 25 .4% and 6 .2% .The prevalence of hypertension and diabetes was 22 .0% and 9 .4% .The independent factor of hypertension was age(OR = 1 .83 ,95% CI :1 .68 - 1 .98) ,education level(OR = 0 .67 ,95% CI :0 .55 - 0 .82) ,body index(OR= 1 .68 ,95% CI :1 .44 - 1 .96) ,blood glucose(OR = 0 .60 ,95% CI :0 .51 - 0 .70) .The independent factor of diabetes was age(OR =1 .33 ,95% CI :1 .20 - 1 .48) ,gender(OR = 1 .48 ,95% CI :1 .11 - 1 .98) ,education level(OR = 0 .77 ,95% CI :0 .60 - 0 .98) ,body in-dex(OR = 1 .40 ,95% CI :1 .16 - 1 .70) and blood pressure(OR = 0 .77 ,95% CI :0 .64 - 0 .93) .Conclusion The prevalence of hyper-tension and diabetes was high .The risk factors such as unhealthy diet ,physical inactivity ,smoking ,harmful alcohol use ,overweight and obesity is common among rural residents .It should be attached an importance on non-communicable disease prevention and con-trol in rural area .

Background The establishment of diabetic animal model is a crucial step for the study about diabetic eye diseases. At present,the main modeling method include the injection of streptozotocin and alloxan. But the shortcoming of the former is an expensive price, and that of the later is high death rate of animals. Objective This experiment was to discuss the way which decrease the death of alloxan-injected animal and explore the effects of high blood glucose on the posterior capsular opacification (PCO). Methods Forty clean healthy male New Zealand white rabbits were randomly divided into 2 groups. 90mg/kg of alloxan were injected via ear vein once in 20 rabbits to create the diabetic animal models,and the equivalent amount of normal saline solution was injected at the same way as normal blood glucose group. The successful models were selected in the animals with the blood glucose level over 12. 0 mmol/L two weeks later, and PCO of lens were graded based on the method of Odrieh under the slit lamp. Extracapsular lens extraction was then performed on the right eye of rabbits in both groups, and the posterior capsules were obtained from these eyes at the 6th, 10th and 14th days after operation. The expression of proliferating cell nuclear antigen ( PCNA ) in posterior capsular lens epithelial cell was detected by immunohistochemistry. Results The modeling successful rate was 70% after injection of alloxan. The body weight of rabbits in high blood glucose group was significantly lowed and the blood glucose was significantly elevated in comparison with normal blood glucose group ( all P<0. 05). Two weeks after surgery ,2 eyes occurred 2 grade of PCO and only one eye showed the 1 grade of PCO in the high blood glucose group. However, 1 grade of PCO was found in 3 eyes in the normal blood glucose group. Biopsy revealed that PCNA was positively expressed in the cell nuclei of LECs in high blood glucose group rather than the normal blood glucose group from the 10th day after surgery. The proliferation index of PCNA was 0. 86±0. 04 and 0. 25±0. 03 respectively in high blood glucose group and normal blood glucose group, showing a significant difference between them (t = -16. 171 ,P = 0. 000). Conclusion Stable diabetic models of rabbits can be created by intravenous injection of 90 mg/kg alloxan. High blood glucose level is one of the important factors for the development of PCO.