Aged ; Coronary Artery Disease ; Female ; Heart Ventricles ; Humans ; Vascular Fistula

Objective To investigate the safety and efficacy of placement of self expandable metallic stent within right atrium and inferior vena cava (ICV) in patients with malignant ICV obstruction involving right atrium. Methods There were 5 male patients with advanced hepatocellular carcinoma, aged from 42 to 65 years (mean 56 3 years). The malignancies invaded right atrium and ICV simultaneously, and caused obstruction of ICV. These patients presented symptoms and signs of obstruction of ICV such as hepatomegaly, ascites, edema of lower extremities. “Z” type stainless steel stents (7 5～10.0 cm in length and 2 5 cm in diameter) were selected for these patients. Part (1.0～3.0 cm in length ) of stent was placed in right atrium and the rest was in ICV. Results All of stents were placed successfully and obstructed ICV reopened. The symptoms of obstruction of ICV relieved or disappeared. There were no recurrence of symptoms of obstruction of ICV and any cardiac complication related to placement of stents in follow up period (67～188 days). Conclusion Placement of self expandable metallic stent within right atrium and ICV in treatment of patients with malignant ICV obstruction involving right atrium is one of the safe and effective methods.

Objective: To observe the therapeutic effects of warm-needling technique on peripheral facial paralysis. Methods: Warm-needling technique and electroacupuncture were employed to treat 30 cases of facial paralysis, respectively. The same acupoints, Cuanzhu(BL 2)towards Yuyao(Ex-HN 4), Yingxiang(LI 20) towards Xiaguan(ST 7), Taiyang(Ex-HN 5)towards Xuanlu(GB 5), Dicang(ST 4) towards Jiache(ST 6), and Chengjiang(CV 24) towards Daying(ST 5), were used. Results: After 33 treatments, the warm-needling technique has an effective rate of 83.3%, while the electroacupuncture 67.7%. Conclusion: The therapeutic effect of warm-needling technique was better than that of electroacupuncture method.

Objective To investigate the influence of immunosuppression strategy optimization on the outcomes of the renal transplant recipients in the last decades. Methods Data from 404 renal transplant recipients from Jan. 1st, 2001 to Dec. 31st, 2010 were analyzed retrospectively. The patients were divided into early transplant group (n = 260) and late transplant group (n= 144). The change of immunosuppression strategy included a low dose antithymoglobin (ATG) induction, a quick corticosteroid reduction and mycophenolate mofetil therapeutic monitoring with calcineurin inhibitor minimization. Recipients' gender,age, donor type, induction therapy, immunosuppression regime, occurrences of biopsy-proven acute rejection (BPAR), severe pulmonary infection and patient/allograft survival were compared between groups. A Cox regression model was used to investigate the factors that influenced the allograft survival. Results The follow-up rate was 98. 3 % in this study. The median follow-up period was 65 month (1-112 months). The proportion of ATG induction in late transplant group was significantly higher than in early transplant group (78. 5 % versus 31. 9 %, P<0. 01). The severe pulmonary infection rate was lower in late transplant group, while the BPAR rate was comparable between two groups. The allograft survival rate was significantly higher in late transplant group. Severe pulmonary infection was correlated with patient/allograft survival in Cox regression model. Conclusion The improvement of outcome in renal transplant recipients in our center is related to the optimization of immunosuppression strategy that reduces the severe pulmonary infection rate with no increase in BPAR.

Objective To explore the roles of MircroRNA-217 ( Mir-217 ) , silent information regulator 1 (Sirt1), and hypoxia-inducible factor-1α(HIF-1α)in high glucose-induced inflammation and fibrosis in rat glomerular mesangial cells( RMCs) . Methods RMCs were pre-incubated with a Sirt1 activator resveratrol prior to high glucose treatment or transfected with Sirt1 small interfering RNA( siRNA) , HIF-1αsiRNA, and Mir-217 inhibitor. Real-time PCR was used to analyze the expressions of Mir-217, Sirt1 mRNA, and HIF-1α mRNA; Western blot was used to observe the protein expressions of Sirt1, HIF-1α, connective tissue growth factor(CTGF), endothelin-1(ET-1), and fibronectin( FN) . Enzyme-linked immunosorbent assay was applied to detect protein expression of transforming growth factor-β1(TGF-β1)and vascular endothelial growth factor(VEGF). Results High glucose increased Mir-217, HIF-1α, CTGF, ET-1, FN, TGF-β1, and VEGF expressions(all P<0. 01), while decreased Sirt1 expression. In addition, Mir-217 gene silencing or 25μmol/L resveratrol suppressed high glucose-stimulated expressions of HIF-1α, CTGF, endothelin-1, FN, TGF-β1, and VEGF(all P<0. 01). Conclusion Mir-217 mediates high glucose-induced inflammation and fibrosis in RMCs via Sirt1/HIF-1αsignal pathway. This study provides new evidence to clarify the protective mechanisms of Sirt1 in diabetic nephropathy.

Objective To study the endogenous metabolites of liver-kidney deficiency syndrome in knee-joint osteoarthritis (KOA) and explore the metabolic profile of KOA liver-kidney deficiency syndrome. Methods Totally 50 cases of KOA with liver-kidney deficiency syndrome and 50 cases of KOA with non-liver-kidney deficiency syndrome were collected respectively, and 20 cases of healthy volunteers were collected as the normal group. The serum samples of subjects were collected after fasting for 8 h. Hydro-Nuclear Magnetic Resonance (1H-NMR) spectrometer was collected. Principal component analysis and partial least squares discrimination analysis were used to conduct multivariate statistical analysis. Results 1H-NMR could identify 23 kinds of metabolites, and there was statistical significance between KOA patients and healthy volunteers (P<0.05, P<0.01). There was statistical significance in cartilage matrix metabolism, energy metabolism, lipid metabolism, pain, inflammation-related metabolites in patients with KOA liver-kidney deficiency syndrome and patients with KOA non-liver-kidney deficiency syndrome (P<0.05). Conclusion Patients with KOA liver-kidney deficiency syndrome have a unique 1H-NMR metabolic profile, KOA syndrome has a metabolic material basis.

AIM: To observe the effect of combined goniosynechialysis in treating absolute glaucoma after trabeculectomy.
METHODS:Phacoemulsification combined goniosynechialysis was performed on 16 patients ( 16 eyes ) with absolute glaucoma after trabeculectomy, and they were followed up for 6 ~12mo, The postoperative intraocular pressure ( IOP ) and anterior chamber depth, preoperative and postoperative medication types (quantity), preoperative and postoperative 1 month's status of anxiety and depression, symptoms of ocular surface were observed. RESULTS: The IOP decreased significantly after phacoemulsification combined goniosynechialysis. The mean IOP was 35. 00±15. 43mmHg preoperatively, and it was 12. 00±6. 69mmHg, 15. 00±4. 26mmHg and 15. 3±5.2mmHg on 1d, 6 and 12mo after the surgery. The statistic difference was found between preoperative and postoperative (t=6. 22, P<0. 05). The anterior chamber depth was 1. 45 ± 0. 19mm before the surgery, and increased to 3. 37±0. 13mm after the surgery (t=6. 65, P<0. 05). After the surgery, 2 patients needed two kinds of drugs, 2 patients needed one kind of drug. After 12mo of follow-up, anxiety and depression status were improved in all 16 patients. Subjective discomfort symptoms of 16 patients such as eye bilges, eye pain were relieved. All of the patients' eyeballs were preserved, and no serious complications.
CONCLUSION: Phacoemulsification combined goniosynechialysis in treating absolute glaucoma after trabeculectomy is a safe and effective surgical option.

Objective To investigate effects of magnetic stimulation on apoptosis of nerve cells and the production of inducible nitric oxidate synthase (iNOS) after spinal cord injury (SCI). Methods Thirty-two SpragueDawley male rats were randomly divided into a magnetic stimulation group (n = 16) and a control group (n = 16).SCI models were established by spinal cord transection in both groups. Rats were sacrificed at the 6th, 12th, 24th and 72nd hour post-injury, but the rats in the stimulation group received magnetic stimulation before being sacrificed.Apoptosis index (AI) and iNOS-positive cells rate were recorded at each time point. Results Apoptotic cells could be observed by the 6th hour post-injury, and were elevated from the 24th to the 72th hour. iNOS-positive cells were few at the first two time points, but had increased significantly at the 24th and 72nd hour post-injury. Compared with the control group, the apoptosis index of the stimulation group decreased a little at the 6th and 12th hour, but not significantly. The difference was quite significant at the 24th and 72nd hour, however, and the AI in the stimulation group decreased much more than that in the control group. There was little difference in the rate of iNOS-positive cells between the control and stimulation groups at any time point. Conclusions Magnetic stimulation could inhibit neural apoptosis and protect neurons from secondary SCI, but it has little effect on iNOS production.

Objective To investigate the resistant mechanism of carbapenem-resistant Escherichia coli and its relationship with endogenous infection. Methods Two carbapenem-resistant Escherichia coli strains were isolated from blood and stool of a same patient, respectively. The minimal inhibition concentrations (MIC) of the two isolates against imipenem and meropenem were determined by E-test. The susceptibility against other antimicrobial agents were done by disc diffusion method. Isoelectric focusing electrophoresis (IEF), polymerase chain reaction (PCR) amplification,cloning and sequencing, conjugation, Southern blotting were carried out to analyze the encoding gene of β-lactamases. Homology analysis of the two strains was done by pulsed field gel electrophoresis (PFGE). Results MIC against imipenem and meropenem of the two strains were both≥32 mg/L.Both strains produced KPC-2 (pI 6.7) and SHV-12 (pI 8.2) β-lactamases. blaKPC2gene was located on a 54 kb transferable plasmid. PFGE showed that the two Escherichia coli strains were derived from the same clone. Conclusions The resistance and enzyme digestion map of chromosome DNA of the two Escherichia coli strains are coincident. The Escherichia coli septicemia of this patient is probably an endogenous infection caused by the immigration of Escherichia coli from the gut.

Objective To assess the cli ni cal usefulness of dual-modality positron emission tomographic (PET)-computed t omographic (CT) imaging in pulmonary lesions. Methods Fo rty-nine patients with pulmonary lesions examined with ?~2 test. Results There were 50 primary lesions in 49 patients. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predict ive value (NPV) were 90.0%, 95.2%, 62.5%, 93.0%, and 71.4%, respectively wi th PET-CT, 74.0%, 76.2%, 62.5%, 91.4%, and 33.3%, respectively with CT. There was significant differences between them (P0.05). Conclusion PET-C T has an important clinical value in differentiating benign lesion from malignan cy and staging in lung cancer.