Objective To investigate the perioperative management and video-assisted thoraco-scopic (VATS) extended thymectomy for myasthenia gravis ( MG ). Methods A total of 102 patients who received extended thymectomy for MG from June 2000 to August 2007 were divided into 2 groups by operative approach: 51 in the VATS group and 51 in the full median sternotomy group. The clinical features, including operation time, operation blood loss, post-operative drainage, inci-dence of crisis, hospital stay, and the 1-year total effective rate after the operation were compared. Complications were treated exactly and cholinesterase inhibitors were applied to control the symptom of MG before the operation. The whole thoracic gland and fat in the anterior mediastinum were removed. Steroid, cholinesterase inhibitors and plasmapheresis were used to prevent and cure masthemic crisis after the operation. Results No patients died in the operation and hospitalization. There was no sig-nificant difference in the operation time [(128.14±34.82) min vs. (130.46±28.71) min] and the 1-year total effective rate after the operation (85.8% vs. 87.2% )in the 2 groups(P>0.05).The operation blood loss, postoperative drainage, incidence of crisis, and postoperative hospital stay in the median sternotomy group were higher or longer than those in the VATS group [(93.77±21.64) mL vs. (45.42±10.96)mL,P<0.05; (174.65±21.64)mL vs. (101.33±28.76) mL,P <0.01;7.84% vs. 1.96%, P<0.05;(14.23±3.17)d vs. (8.37±1.18)d, P<0.05)]. Conclusion VATS extended thymectomy for myasthenia gravis is safe, less invasive and effective. Preoperative preparation and the perioperative managemant can decrease the incidence of crisis. The plasmapheresis is the key of curing masthemic crisis.

Objective To investigate the protective effects and mechanism of nitric oxide(NO) inhalation on rabbit lung ischemia/reperfusion injury. Methods Total 32 Japanese white rabbits were randomly divided into four groups, each group containing 8 rabbits. In group A, animals received only thoracotomy. In group B, after animals left chest were opened, their left main pulmonary arteries were occluded for 2h, then reperfused for another 2h. In group C, animal inhaled 20 ppm NO for 30min since the eleventh minute after reperfusion. In group D, animal inhaled 60ppm NO for 30min since the eleventh minutes after reperfusion. The levels of blood PaO 2, cGMP, slCAM-1, XOD and MDA were measured before operation and after reperfusion. The pathologic changes of left lung was observed. The wet/dry (W/D) weight ratio of left lung tissue was measured. Results Both PaO 2 and cGMP levels after reperfusion in group B were much lower than that in groups A, C and D(P

Objective To study on the activity of intestinal mucosal mast cells (IMMC) in dextran sulfate sodium ( DSS) induced colitis of rats. Methods Acute colitis was induced by giving 3% DSS orally. Eighteen male rats were randomized into DSS group ( n = 10 ) and normal control group ( n = 8). The rats in DSS control group drank 3% DSS solution from day 1 to day 7; those in normal control group drank water at random. Diarrhea and bloody stool as well as colonic histology were observed. The levels of colonic tissue histamine, tumor necrosis factor-a (TNF-a) and Prostaglandin E2 ( PGE2) determined with fluorimetry and ELISA, and the expression of IMMC in colonic tissue was detected by histochemical stain method. Results Compared with normal control group, the inflammatory symptoms and histologjcal damages of colonic mucosa in DSS group were significantly presented. The level of histamine in colonic tissue was significantly reduced (P

Objective Stress effect plays an important role in the development of some myocardial diseases. We hypothesized it was important nosogenesis to myocardial damage and cardiac allograft vasculopathy. Methods The transplanted hearts from Lewis to Wister rats served as allografts and from Lewis to Lewis rats as isografts based Ono's model. The differential proteins in the transplanted hearts were separated by comparative proteome, and then identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS) and searched by Matrix Science software system.Results All transplanted hearts were characterized by lumen loss [(total vessel area-luminal area)/total vessel area] in the coronary artery 2 weeks after the operation [(2.07%±0.93%) vs. (27.58%±11.14%), P＜0.01], but more predominant after 8 weeks [(2.34%±1.06%) vs. (72.29%±20.57%), P＜0.01]. All samples of the left ventricle were analyzed by proteomic techniques and 37 distinct proteins involving their respective isoforms and subunits were identified. Nine proteins were correlated to endoplasmic reticulum stress effect and myocardial damage, and 2 proteins were verified by Western blot.Conclusion Stress plays an important role in cardiac allograft damage and the development of rat cardiac allograft vasculopathy.

Objective To investigate the feasibility of CT pulmonary angiography (CTPA) with 80 kVp and contrast agent of iodixanol (270 mg I/ml) by filtered back projection(FBP) reconstruction.Methods In total,52 patients who underwent CTPA were randomly divided into two equally-sized groups,control group and experimental group.The volume computed tomography dose index (CTDIvol) and dose-length product (DLP)were recorded,and the weighted computed tomography dose index (CTDIw) and effective dose (E) were calculated.The image quality was visually evaluated and measured,and statistical analyses were performed on the image quality and the radiation dose.Results The sex,age,height,weight and body mass index (BMI) had no statistical difference between two groups (P ＞ 0.05).The average iodine dosage decreased by 22.9％ in the experimental group compared with the control group.Compared with the control group,the CTDIvol,DLP,CTDIw and E decreased by 73.5％,75.1％,73.5％ and 75.8％,respectively.The differences were statistically significant (t =＜0.001,30.5,＜ 0.001,-28.7,P ＜ 0.05).The image quality of the two groups met the requirement of diagnosis and there were no significant statistic differences between visually evaluating and objectively measuring the image quality (P ＞ 0.05).Conclusions Using 80 kVp and iodixanol for CTPA,FBP reconstruction image quality can meet diagnostic requirements.At the same time the radiation dose,the contrast agent dose and the X-ray tube wastage are reduced respectively.

ObjectiveTo evaluate the clinical efficacy and safety of astragalus injection on the immune function in patients with senile sepsis.Methods Sixty patients with old age sepsis in Critical Care Medicine Department of Guangdong Provincial Traditional Chinese Medicine Hospital were enrolled and randomly assigned into control and treatment groups according to the table of random numbers, 30 cases in each group. According to 2012 sepsis guidelines for treatment, including antibacterial drug, mechanical ventilation, visceral function support, etc., the therapy was given to the control group; besides the treatment in the control group, intravenous drip of 60 mL astragalus injection(10 mL per ampoule) in 250 mL 0.9% normal saline was additionally given in the treatment group, once a day for 7 days. Before and after treatment, the immunological indexes, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment(SOFA) score, duration of mechanical ventilation and time of stay in intensive care unit(ICU), 28-day mortality and adverse drug reactions were compared between the two groups.Results Before treatment, there were no statistically significant differences in CD3+, CD3+CD4+, CD3+CD8+ and T helper cells /T suppressor cells(Th/Ts)levels between the two groups(allP>0.05), while CD3-NK+ of the control group was significantly higher than that in the treatment group〔(10.47±6.22)% vs. (6.26±4.13)%,P<0.05〕. After treatment in treatment group, CD3+, CD3+CD4+ and CD3-NK+ were increased, CD3+CD8+,Th/Ts were decreased compared with those before treatment; in the control group after treatment, CD3+,CD3+CD8+ and CD3-NK+ were decreased and CD3+CD4+ and Th/Ts increased compared with those before treatment. In the comparisons between the treatment group and control group after treatment, the differences in CD3+, CD3+CD4+ and CD3+CD8+ had statistical significance〔CD3+:(30.30±17.17)% vs.(41.91±22.29)%, CD3+CD4+:(31.54±13.24)% vs.(40.08±15.28)%, CD3+CD8+:(14.25±8.10)% vs.(9.52±9.33)%,allP<0.05〕; while the differences in Th/Ts and CD3-NK+ had no statistical significance(bothP>0.05). After treatment in the treatment group, IgG was increased compared with that in the control group〔IgG(g/L): 13.07±5.43 vs. 10.10±3.96,P<
0.05〕. The differences in IgA, IgM, complement(C3,C4) and total serum complement activity(CH50) in the comparisons between the two groups had no statistical significance after treatment(allP>0.05). The differences in APACHEⅡ score(13.83±6.18 vs. 15.90±7.48), SOFA score(7.38±4.66 vs. 6.89±4.19), time of stay in ICU(day: 11.63±5.13 vs. 13.62±8.08), invasive ventilation time(hour: 155.44±119.68 vs. 224.08±174.15) and noninvasive ventilation time(hour: 55.55±42.24 vs. 98.57±43.17) had no statistical significance in comparisons between the treatment group and control group after treatment(allP>0.05). The difference in 28-day mortality had no statistical significance in comparison between the treatment group and control group〔16.7%(5/30) vs. 20.0%(6/30),P>0.05〕. In 60 cases, there were 2 patients with adverse drug reaction, one diarrhea and another little rashes, the rest of the patients did not appear any drug side effect.ConclusionAstragalus injection combined with conventional western medicine therapy possibly has certain effect on adjustment of disturbance of immunologic functions in old patients with sepsis, and its therapeutic safety is well.

Objective To study the in vivo expression patterns of caspase-3 in normally aged primate brain. Methods Fresh brain tissue was taken from 4-year-old and 20-year-old female rhesus monkeys,4 for each age group. In vivo distribution of caspase-3-positive cells and its protein levels in different brain regions were investigated by immunohistochemical and immunoblot means,respectively. Results In the frontal cortex,most neurons lacked detectable caspase-3 immunoreactivity,whereas low to moderate caspase-3 immunostaining was found mainly in pyramidal cells in CA1,CA3 and CA4 subdivisions of hippocampus. And in the cerebellum,a small number of Purkinje cells were strongly stained in their cytosol and dendrites,while their nuclei lacked staining. Age-related changes in caspase-3 expression pattern were not found. Immunostaining of motor cortex in aged monkeys localized strong caspase-3 immunoreactivity to a limited number of large pyramidal cells in layer V. Immunoblotting revealed the 32 000 caspase-3 progenitor in all three brain regions. There were no differences in caspase-3 expression levels as a function of either brain region or age of animals. Conclusions These results suggest that caspase-3 is constitutively expressed in matured primate brain and there is no significant age-related change in its expression.

objective To detect CK19 mRNA and CEA mRNA in blood of the peripheral vein and to investigate the effect of ligating pulmonary vein firstly or ligating pulmonary artery firstly during surgical operation on haematogenous dissemination of malignant cells.Methods Fifty six non-small cell lung cancer patients were collected and random assigned to two groups before operation (ligating pulmonary vein firstly or ligating pulmonary artery firstly).The patients were accepted radical operation and their operations were put in practice by doctors of one team.Vein blood was collected one day before operation and one week after operation.CK19 mRNA and CEA mRNA in blood were detected by nested reverse transcriptase-polymerase chain reaction. Result The positive rate of expression of CK19 mRNA and CEA mRNA after operation is lower than that before operation.The positive rate of expression of CK19 mRNA and CEA mRNA in ligating pulmonary vein firstly after operation is lower than that in the other group. Conclusions Surgical operation have effects on the dissemination of malignant cell and ligating palmonary vein firstly during operation can reduce the dissemination of malignant cell.

ObjectiveTo investigate the value of 64-slice CT urography (CTU) in diagnosis of urologic diseases.Methods Sixty patients with suspected urinary system diseases underwent 64-slice CT volume scanning and 3D reconstructions.The diagnostic value of 64-slice CTU was evaluated.ResultsThere were 14 patients with urinary system cancers,2 with ureter polyp,9 with tuberculosis of urinary system,13 with urinary system calculus,13 with nonmalignant ureterostenosis combined with hydronephrosis,2 with ureterostenosis and hydronephrosis induced by nearby organic damage,2 with traumatism,1 with renal occlusion,as well as 4 after urinary tract surgeries and 2 without abnormality.Totally 28 cases was confirmed with surgery and pathology,the sensitivity,specificity and accuracy of MSCTU for upper tract tumor was 100％(14/14),85.71％ (12/14) and 92.86％ (26/28),respectively.ConclusionMSCTU is able to directly and clearly show urologic diseases.It can be regarded as the first choice in patients with clinically suspected urinary tract diseases,especially tumors.

Objective To investigate the characteristics of breast neoplasms on contrast-enhanced ultrasonography(CEUS) and its clinical value.Methods Two hundred and twenty-five patients with breast masses unable to be diagnosed by conventional ultrasonography were examined with CEUS.The characteristics of these masses on CEUS were analyzed and compared with the results of pathology examination.Results The typical features of breast cancers on CEUS were enlarged maximum diameter of the lesions on CEUS compared to pre-contrast ( P ＜0.05),irregular shapes,heterogeneous distribution of contrast enhancement with perfusion defect or local retention of contrast signals,tortuous,massive or penetrating vessels rapidly entering and exporting from the lesions.The sensitivity and specificity of perfusion defect for breast cancer on CEUS were 89.0％ and 91.8％,respectively; the sensitivity and specificity of local retention of contrast signals for breast cancer on CEUS were 93.4％ and 92.5％,respectively.Conclusions It is valuable for CEUS in the diagnosis and differential diagnosis of breast neoplasms clinically.