Objective:To investigate the reasons and treatment measures of heparin resisitance in patients undergoing cardiac surgery during cardiopulmonary bypass(CPB).Methods:Retrospective analysis of 1 258 patients undergoing cardiac surgery was made.Results: After 400 U/kg heparin was injected intravenously,the activated clotting time(ACT)could not be extended to 480 seconds or was shortened soon after extended to 480 seconds in nineteen patients(1.51%)including seven patients with cardiac myxoma,three patients with rheumatic heart disease,three patients with infective endocarditis patients,two cases of atrial septal defect patients,two cases of tetralogy of Fallot patients,one cases of ventricular septal defect patient and one cases of double outlet right ventricle patient.A large number of heparin was added to maintain ACT at safe range for anticoagulation.But it was invalid for five patients to add heparin,and then ACT could be extended to 480 seconds after 400～600 ml fresh frezon plasma or blood was transfused.Conclusion:Heparin resistance was commonly encountered in cardiac myxoma,infective endocarditis and cyanotic heart diseases requiring CPB.It was associated with the appearance of similar heparin mucopolysaccharide material in the blood,decrease of antithrombinⅢ(ATⅢ)content and activity,increase of platelet count,preoperative anticoagulant therapy and the use of contraceptives.ACT should be monitored frequently during CPB.

Objective:To investigate the effect of JAK2/STAT3 pathway on myocardial protection of tetrodotoxin(TTX) cardioplegia in rat hearts.Methods:A total of 24 Wistar rats were randomly divided into Group Control,Group TTX and Group TTX+AG490(n=8).The left ventricular samples in Group Control were collected as pre-ischemia control through thoracotomy.After isolated heart Langendorff and Neely models were established,the rat hearts in Group TTX were continuously perfused with Krebs-Henseleit(K-H) buffer solution for 30 minutes,arrested by TTX cardioplegia(4℃) for 60 minutes,and underwent reperfusion with K-H buffer solution for 60 minutes,then the left ventricular samples were collected for detections.The rat hearts in Group TTX+AG490 were perfused and reperfused with JAK2 inhibitor AG490(5?mol/L) and K-H buffer solution under the same procedure as Group TTX.The protein expression indexes(PEI) of phosphorylated-STAT3(p-STAT3) and B-cell lymphoma-2(Bcl-2) in myocardium were detected by immunohistochemical assay(IHC).The apoptosis index(AI) of cardiomyocyte was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling(TUNEL).The changes of these indexes in three groups were used for comparison.Results:Compared with Group Control,the PEI of p-STAT3 and Bcl-2 in Group TTX and Group TTX+AG490 increased significantly(P

BACKGROUND:The key difference between closed reduction and open reduction for femoral neck fracture is the incision of joint capsule or not. As for this problem, scholars have different opinions, but there is no unified conclusion. OBJECTIVE:To compare reduction quality and the rate of femoral head necrosis of open reduction and closed reduction in the treatment of femoral neck fracture in middle-aged and young patients with displaced femoral neck fracture. METHODS: Clinical data of 102 middle-aged and young patients with femoral neck fracture, who were treated in the Department of Traumatic Orthopedics, Guizhou Orthopedic Hospital from June 2008 to June 2014, were analyzed. They were folowed up. According to the manner of reduction, they were divided into open reduction group (n=39) and closed reduction group (n=63). General data, postoperative fracture healing, the rate of femoral head necrosis and reduction quality were compared between the two groups. RESULTS AND CONCLUSION:No significant difference in general information, preoperative and postoperative hemoglobin difference, fracture healing time and fracture nonunion rate was detected between the two groups (P > 0.05). The rate of femoral head necrosis was lower in the open reduction group than in the closed reduction group, but reduction quality was higher in the open reduction group than in the closed reduction group (P < 0.05). These results indicate that in the treatment of displaced femoral neck fractures in middle-aged and young patients, postoperative femoral head necrosis rate of open reduction and fixation is low, and the quality of reduction is better. Open reduction has a certain advantage, but the case number and case study have a certain limitation. We should choose the appropriate way of operation treatment according to the patient’s condition.

OBJECTIVE To investigate the relationship of obstructive sleep apnea hypopnea syndrome (OSAHS) and hyperglycemia by analyzing the level of blood-fasting sugar (BFS) in patients with OSAHS. METHODS The data of BFS and AHI in patients with OSAHS (n=300) and the data of BFS of controls (n=225) were collected. The difference of high blood glucose in the OSAHS and the controls.and the difference of AHI between OSAHS patients with high blood glucose and OSAHS patients with normal blood glucose was analyzed. RESULTS There were 97 patients (32.3 %) with high BFS in 300 OSAHS patients, but only 14 cases (6.2 %) with high BFS in 225 controls. There was a significant difference between two groups. The average of AHI in OSAHS patients with high BFS was 67.8/h, and average of AHI in OSAHS patients with normal BFS was 38.4/h. There was a significant difference between the two groups. CONCLUSION There is a close correlation of OSAHS and hyperglycemia.

Objective To explore the safety and clinical efficacy of the purse string suture stitched in gastric wall of anastomotic stoma for intrathoracic esophagogastric apparatus anastomosis.Methods The clinical data of 238 patients with thoracic esophageal carcinoma and 24 patients with carcinoma of the esophagogastric junction received intrathoracic apparatus anastomosis at the Sichuan Provincial People's Hospital from January 2008 to December 2011 were retrospectively analyzed.There were 122 patients received conventional intrathoracic esophagogastric anastomosis (conventional group) and 140 patients received purse string suture stitched in gastric wall of anastomotic stoma before intrathoracic esophagogastric anastomosis (improvement group).The incidences of anastomotic fistula and stenosis of the 2 groups were compared.All data were anlayzed using the t test,chisquare test or Fisher exact probability.Results There were no significant differences in the operation time,intraoperative blood loss,volume of drainage of peritoneal effusion within 24 hours after operation,postoperative hospital stay and postoperative pTNM staging between the 2 groups (t =0.410,0.798,0.634,0.362,x2=0.605,P ＞ 0.05).There were no significant differences in the anastomotic location,stapler type,the weight of stapler esophageal end tissue between the 2 groups (x2 =0.118,0.221,t =0.459,P ＞ 0.05).There were no significant differences in the incidences of pulmonary complication,arrhythmia and mortality between the 2 groups (P ＞ 0.05).The weight of stapler stomach end tissue in the improvement group was significantly greater than that of the conventional group,while the incidences of postoperative anastomotic fistula and stenosis of the improvement group were significantly lower than those of the conventional group (t =13.856,P ＜ 0.05).Conclusion The purse string suture stitched in gastric wall of anastomotic stoma for intrathoracic esophagogastric apparatus anastomosis is simple and safe,and could effectively reduce the rate of anastomotic fistula and stenosis.

Objective: To establish the quality control standard of Xiangshapingwei Pills (Rhizoma Atracylodis Pericarpium Citri Reticulatae Cortex Magnoliae Officinalis Radix Aucklandiae etc.)Methods: Rhizoma Atractylodis , Radix Auklandiae, Cortex Magnoliae Officinalis, Pericarpium Citri Reticulatae in Xingshapingwei Pills were identified by TLC. The content of hesperidin in Xiangshapingwei Pills was determined by RP HPLC with C 18 reversed phase column, mobile phase (methanol∶water∶acetic acid=30∶65∶5),detection wavelength at 283nm and flow rate 1.0mL?min -1 .Results: Hesperidin showed a good linear relationship at a rang of 0.8～4.0?g. r = 0.9993 . The average recovery was 96.7%, and RSD was 2.42%.Conclusion: The method is accurate and quick, and can be used for the quality control of Xiangshapingwei Pills.

Objective To summarize the clinical experience of off-pump coronary artery bypass grafting (OPCABG) for treating high risk coronary artery disease (CAD,SinoSCORE ≥ 6 points),and to evaluate its safety and efficacy.Methods The clinical data of 73 patients with high risk coronary artery disease treated through OPCABG (high risk group)in our center from April 2012 to December 2015 were retrospectively analyzed and compared with those of other low or moderate risk 78 patients treated through OPCABG (SinoSCORE＜ 6 points,low or moderate risk group) at the same period.Results All operations in the high risk group were successfully performed.Compared with the low or moderate risk group,the rate of using left internal mammary artery grafts in the high risk group was reduced significantly (P＜0.05),the operation time,postoperative ventilator support time,postoperative intensive care unit stay time and postoperative hospitalization time were prolonged significantly (P＜0.05),the rate of using intraaortic balloon pump support was increased significantly (P＜0.05),and the occurrence rate of postoperative severe complications was also increased significantly (P＜0.05).Sixty-nine cases were postoperatively followed up for (18.3±8.6) months.During the following-up period,2 cases died.11 branches of internal mammary artery grafts patency (11/11) and 38 branches of great saphenous vein grafts patency (38/43) were confirmed in 18 cases by coronary artery computer tomography angiography or coronary angiography.One cases was performed the PCI therapy due to angina relapse,and other cases had no angina symptoms with good life quality.Conclusion OPCABG is a relatively minimally invasive and safe operative mode.Strengthening perioperative management can reduce the operation risk and achieves good short or middle term efficacy in the patients with high risk CAD.

Objective To investigate the safety of left atrial appendage occlusion by silk thread ligation during open heart op‐eration in patients with rheumatic atrial fibrillation ,and to evaluate its effectiveness for prevention of cerebral embolism .Methods From April 2012 to March 2014 ,129 patients with rheumatic atrial fibrillation were undergone mitral valve replacement and left at‐rial appendage occlusion by ligation using two silk threads from the outside of the heart (ligation group) .The indexes related to the operation ,postoperative complications incidence ,and cerebral embolism incidence during the follow‐up period of ligation group were compared with the indexes of another 129 patients without ligation of left atrial appendage over the same period (control group) . Results The operation time ,the cardiopulmonary bypass time ,the clamp time ,the intensive care unit stay time ,the postoperative hospitalization time in ligation group were (235 ± 50)min ,(88 ± 24)min ,(57 ± 16)min ,(26 .5 ± 9 .3)h and (12 .4 ± 7 .5)d respective‐ly ,and significant difference was not found compared with control group (P>0 .05) .The thoracotomy for hemostasis(1 cases) ,low cardiac output syndrome(2 cases) ,acute renal failure(2 cases) ,pulmonary infection(3 cases) ,sternal wound dehiscence(2 cases) and other complications in ligation group had no significant difference ,compared with control group(P>0 .05);2 cases died in liga‐tion group ,3 patients died in control group ,the differences had no statistical significance(P>0 .05) .No cerebral embolism occurred in ligation group with 127 patients following‐up (23 .6 ± 11 .3) months ,but 5 patients suffered from cerebral embolism in control group with 126 patients following‐up (22 .9 ± 12 .1) months ,the difference had statistical significance(P<0 .05) .Conclusion Left atrial appendage occlusion by silk thread ligation during open heart operation in patients with rheumatic atrial fibrillation is simple and safe ,can reduce cerebral embolism incidence .

Objective To analyze the cost-benefit ratio of primary trigeminal neuralgia patients with bad drug control and never accepted the surgical treatment through surgery [including microvascular decompression (MVD) ,percutaneous radiofrequency rhizotomy (RFR) ,stereotactic radiotherapy (SRS)] .Methods A total of 89 patients with primary trigeminal neuralgia who under-went surgical treatment for the first time from 2005 to 2013 were enrolled in this study ,including 27 patients with MVD ,23 patients with RFR and 39 patients with SRS .Evaluation criteria (effect factors) include facial pain (excellent :no pain and no drug treat-ment ;good :no pain but medication ;worse:less than 50% of patients with pain ;worse:more than 50% of patients with facial pain or need to undergo secondary surgery ) ,numbness ,cost and .Results The mean age of the patients treated with MVD was (50 .4 ± 14 .3)years old ,RFR was(73 .2 ± 13 .6) years old SRS was (72 .6 ± 11 .8) years old ,MVD group was younger than RFR and SRS group(P<0 .05);The average total cost of each surgical approach as follows :MVD was 50274 yuan ,RFR was 4539 yuan ,SRS was 38512 yuan (P<0 .05);The postoperative facial numbness proportion of MVD was 1 .1% ,RFR was 52 .2% and SRS was 28 .2% (P<0 .05);The ratio of patients who needed recurrent surgery in two years was MVD 26 .0% ,RFR 73 .9% and SRS 30 .7% (P<0 .05);The mean remission rate of MVD was 1 .6 years ,the RFR was 2 .1 years ,and the SRS was 1 .0 year(P<0 .05);The cost-benefit ratio of MVD was 31618 yuan ,RFR was 1982 yuan ,SRS was 39297 yuan(P<0 .05) .Conclusion The cost-ben-efit ratio of the three surgical from low to high were RFR ,MVD ,SRS ,which means the unit cost of RFR gain the highest ,followed by M VD and SRS .

Objective To compare the treatment effect of surgically clipping anterior circulation aneurysms by lateral supraorbital approach and supraorbital keyhole approach for guiding the selection of surgical approach for anterior circulation aneurysms.Methods The clinical data of 80 patients diagnosed as anterior circulation aneurysms due to spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed,including the operation time,craniotomy time,cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge,GOS scores at discharge were compared between the two groups and the literatures were reviewed.Results The operation time and craniotomy time of the lateral supraorbital approach were less than those of the supraorbital keyhole approach,and the differences between the two groups were statistically significant (P＜0.05);the cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge and GOS scores at discharge had no statistical differences between the two groups (P＞0.05).Conclusion The lateral supraorbital approach has the advantages of shorter operation time and craniotomy time,providing a better surgical field during operation,less intraoperative traction and less postoperative complications,and can serve as an alternative scheme for the supraorbital keyhole approach in clipping anterior circulation aneurysms.