Objective The aim of this study was to compare recent clinical efficacy between a novel guidance method for percutaneous pedicle screw placement and the conventional fluoroscopic method for long segments thoracolumbar vertebral fracture without nerve injury. Methods A total of 38 patients with thoracolumbar vertebral fracture in our hospital from September 2010 to December 2012 were divided into group A and group B.Eighteen patients in group A underwent 200 percutaneous pedicle screw fixation by conventional fluoroscopic meth-od.Twenty patients in group B underwent 210 percutaneous pedicle screw fixation by a novel guidance method.All the operation for 38 cases were performed by the same surgeon.The time of insertion,radiation exposure,and accuracy of the screw placement between the two groups were compared.The accuracy of screws was evaluated and graded by two consecutive postoperative CT of operation segment for two groups. Results The mean time for a single pedicle screw placement was (13.11 ±2.32)minutes in group A and (10.35 ±1.92)minutes in group B,respectively.The average radiation exposure was (8.11 ±1.15)s in group B and (13.07 ±2.06)s in group A respectively.The differ-ences were statistically significant for both screw placement and radiation exposure times (P <0.05).A total of 172 screws (86.00%)in group A and 185 screws (88.09%)in group B were perfectly located within the pedicle.The statistical difference of grade A between two groups was not significant(P >0.05).Conclusion The novel guidance system can significantly reduce the insertion time and radiation expo-sure for long segments percutaneous pedicle screw placement,which provides the same accuracy for screw placement compared with the con-ventional method.

Humans ; Hydrocarbons, Chlorinated ; poisoning ; Propane ; analogs & derivatives ; poisoning

Objective: To explore the clinical response on cardiac resynchronization therapy (CRT) in patients of chronic heart failure (CHF) with different QRS wave morphology. Methods: A total of 52 CHF patients received CRT in our hospital and the Seventh People's Hospital of Zhengzhou City from 2010-03 to 2013-07 were retrospectively studied. The patients were divided into 3 groups: True-complete left bundle branch block (t-CLBBB) group,n=20, Classic LBBB (CLBBB) group,n=15 and IVCD group,n=17. The general clinical condition, the indexes of echocardiography at 6 months of follow-up study including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), NYHA classiifcation and 6-MWT were examined and compared among different groups. Results: In general clinical condition, the ratio of non-ischemic heart disease patients in t-CLBBB group was higher than those in CLBBB group and IVCD group, allP<0.05. By 6 months follow-up study, LVEDD in t-CLBBB group (62.6 ± 8.9) mm was lower than those in CLBBB group (70.0 ± 8.9) mm and IVCD group (72.8 ± 8.0) mm, LVEF was higher in t-CLBBB group (38.5 ± 6.2) % than those in CLBBB group (31.7 ± 6.7) % and IVCD group (30.1 ± 6.7) %. NYHA classiifcation in t-CLBBB group (2.00 ± 0.45) grade was lower than those in CLBBB group (2.73 ± 0.80) grade and IVCD group (3.12 ± 0.78) grade . 6-MWT in t-CLBBB group (302.0 ± 57.9) m was longer than those in CLBBB group (257.3 ± 59.0) m and IVCD group (220.2 ± 57.9) m, allP<0.05. Conclusion: CRT is an effective method for treating CHD patients, different QRS morphology may have different response, the patients with t-CLBBB would make better response.

Objective: To evaluate the short-term effect of thrombus aspiration catheters combining tiroifban medication for myocardial tissue reperfusion recovery in patients with acute ST-elevation myocardial infarction (STEMI).
Methods: A total of 105 STEMI patients with percutaneous coronary intervention (PCI) in our hospital from 2011-05 to 2013-05 were studied, there were 73 male and 32 female with the mean age of (58.39 ± 10.37) years. The patients were randomly divided into 2 groups, Group A, the patients received thrombus aspiration catheters with intravenous tiroifban, n=53 and Group B, the patients received tiroifban and PCI, n=52. The basic clinical features, myocardial tissue perfusion level, major adverse cardiovascular events (MACE) at post operative and in-hospital period were recorded, the cardiac function was examined by echocardiography at 6 months after PCI in both groups.
Results: The basic clinical features were similar between 2 groups. The thrombolysis in myocardial infarction trial (TIMI) 3 lfow rate was higher in Group A than that in Group B (92.45% vs 55.77%), P=0.000. TIMI 2 and TIMI 0~1 lfow rates were lower in Group A than that in Group B (7.55%vs 26.92%), P=0.008 and (0%vs 17.31%), P=0.002. The adjusted TIMI frame was lower in Group A (27.26±5.50) vs (38.98±5.42), P<0.001. The echocardiography at 6 months after PCI indicated that Group A had higher LVEF than that in Group B (0.55±0.06) vs (0.47±0.06), P<0.001;lower left ventricular end diastolic diameter (50.77±5.45) vs (54.76±5.34), P<0.001;less angina and target vessel revascularization (16.98%vs 40.38%), P=0.008 and (9.43%vs 17.31%), P=0.008. The incidence of MI, acute heart failure, cardiac death and non-target vessel revascularization were similar between 2 groups, P>0.05.
Conclusion:Thrombus aspiration catheters combining tiroifban medication may obviously improve the myocardial tissue reperfusion and the short-term cardiac function in STEMI patients after PCI, it could reduce the incidence of no-relfow without increasing MACE.

Objective To investigate the effect of multidisciplinary physician/nurse collaboration care mode in diagnosis and treatment of elderly patients with intertrochanteric fracture.Methods Clinical data of 433 elderly patients with intertrochanteric fracture treated from August 2011 to September 2013 were studied retrospectively.Among them,136 were diagnosed and treated using conventional methods (control group) and 297 using the multidisciplinary physician/nurse collaboration approach (collaboration group).Hospital stay,surgery rate,time from hospitalization and operation,and complications were compared between the two groups.Results Length of hospital stay [(14.8 ± 5.9) d] in collaboration group was not statistically different from that in control group [(16.0 ± 4.7) d,t =0.433,P ＞ 0.05],but surgery rate was improved (72.8％ vs 83.9％,x2 =7.212,P ＜ 0.05),time from hospitalization and operation shortened [(5.6 ± 2.9) d vs (6.9 ± 3.4) d,t =3.096,P ＜ 0.05],and perioperative complication rate reduced in collaboration group compared to control group (all P ＜ 0.05).Conclusion Multidisciplinary physician/nurse collaboration mode is a novel method for diagnosis and treatment of intertrochanteric fracture in the elderly and is associated with improved surgery rate,reduced perioperative complications and early functional recovery.

Objective To investigate the changes in serum matrix metalloproteinase(MMP)-2 and MMP-9 and their relationship with serum B-type brain natriuretic peptide(BNP)in patients with chronic heart failure.Methods MMP-2,MMP-9 and serum BNP levels were measured in 184 patients with chronic heart failure and 61 healthy controls.The relationship between changes in MMP-2 and-9 and serum BNP was analyzed.Results Chronic heart failure was categorized into grade Ⅱ,Ⅲ and Ⅳ according to NYHA.In grade Ⅱ,Ⅲ and Ⅳ and the control group,the levels of MMP-2 were(309.1±60.1)nmol/L,(422.6±89.6)nmol/L,(694.8±126.2)nmol/L and(217.2±26.3)nmol/L respectively,and the levels of MMP-9 were (321.2±63.2)nmol/L,(454.4±96.3)nmol/L,(634.1±51.2)nmol/L and(210.8±23.6)nmol/L respectively.The levels of MMP-2 and MMP-9 were significantly higher in chronic heart failure subgroups than in the control group(F=3.65,12.52;P=0.000,0.000).According to the pairwise comparison among the chronic heart failure subgroups,the levels of serum MMP-2 and MMP-9 were significantly higher in NYHA Ⅳ grade than in NYHA Ⅲ grade,and higher in NYHA Ⅲ grade than in NYHA Ⅱ grade(all P<0.05).In patients with chronic heart failure groups,MMP-2 was positively correlated with serum BNP(r=0.866,P=0.000),and with MMP-9(r=0.516,P=0.001).Conclusions MMP-2 and MMP-9 levels might be closely correlated with chronic heart failure and show an upward trend with the progression of chronic heart failure.The levels of MMP-2 and MMP-9 are associated with BNP,which indicates that clinical monitoring of the serum level changes can provide a certain reference for diagnosis,treatment and prognosis in patients with chronic heart failure.

Objective To discuss the timing and procedures of reoperations on the residual aortic dissection after initial ascending aortic operations on Stanford type A aortic dissection.Methods From March 2009 to November 2011,16 consecutive patients(13 males,3 females) underwent reoperations on the residual aortic dissection.The mean age was 44 years(23-61 years),8 cases was associated with Marfan syndrome.The right axillary artery or femoral artery cannulation was used for cardiopulmonary bypass,cerebral protection was achieved by unilateral antegrade brain perfusion and nasopharyngeal temperature was dropped to 20℃-25℃.The Sun's procedure (total arch replacement with stented elephant trunk implantation) was performed in all patients,concomitant procedure include aortic root replacement (Bentall procedune) in 3 patients,aortic root replacement and coronary artery bypass grafting (Bentall + CABG) in 1 patient,the coronary artery anastomotic leakage repair in 1 patient,mitral valve replacement (MVR) in 1 patient.Results The interval between two operations averaged(66 ±40)months.The means of cardiopulmonary bypass,cross clamp and selective cerebral perfusion times were(193 ± 49)minutes,(90 ±28) minutes and(22 ± 10) minutes,respectively.The mean time to tracheal extubation was(17 ± 10) hours.All patients survived from the operation.One patient suffered from temporary left lower limb paralysis and recovered after treatment during follow-up.Computed tomography angiography (CTA)of aorta was performed on each patient before discharged from the hospital:descending aortic true lumen was significantly expanded,thrombosis of false lumen was found near stent graft.The average follow-up time was 17 (3-42) months,one patient died of aortic rupture 3 months later,one patient underwent total thoracoabdominal aorta replacement 6 months later,one patient with descending thoracic aortic dilatation combined with endometrial tear underwent thoracic endovascular aortic repair.Conclusion Reoperation should be performed as the following condition:the annual growth rate of residual aortic diameter exceeds 0.5 cm/year,the maximal aortic diameter exceeds 5 cm.The Sun's procedure (total arch replacement with the elephant trunk implantation) is safe and effective in the treatment of residual aortic dissection,low mortality and complications was achieved by it,the mid-and long-term results need the further follow-up.

Objective To investigate the relationship between the systolic/diastolic orthostatic hypotension(OH S/OH-D) and myocardial infarction (MI) in the elderly.Methods 200 subjects without myocardial infarction (MI) aged 60 years and over in our urban district were selected.The orthostatic and supine blood pressure and heart rate were measured in supine position after resting for more than 5 minutes and at 0 and 2 minutes after standing.All eases were divided into systolic orthostatic hypotension(OH-S)or diastolic orthostatic hypotension(OH-D)groups based on the results of orthostatic hypotension,and followed up by telephone with mean period of 325 days.The primary endpoint was MI occurrence for analyzing the correlation between OH-S/OH-D and MI incidence.Results The prevalence rate of OH in this cohort was 38％,with OH-S 20％ and OH-D 18％.In the very elderly group(≥80 years)versus the elderly group,the occurrences of 0H and OH-S were(27％ vs.21 ％,P =0.036;22 ％ vs.15 ％,P =0.020),respectively,while no significant difference was found in OH-D between the two groups.After 325 day follow up,the prevalence of MI was significantly(P＜ 0.05)higher in the OH positive subjects than in the 0H negative subjects,which result was the same as the prevalence of MI in OH-S or and OH-D group.After adjusting for age,supine blood pressure,creatinine and cerebrovascular history,logistic regression analysis showed that MI was correlated with OH(HR 15.72,95％CI 3.29～74.23,P=0.002),OH-S(HR 8.552,95％CI 2.51～30.21,P=0.004)and OH-D(HR 3.80,95 ％CI 1.14～13.80,P=0.042).Compared with OH-D,OH-S had more significant correlation with MI.Conclusions Orthostatic hypotension,particularly systolic orthostatic hypotension,is common in elderly patients.The OH-S and OH-D have a significant correlation with MI.

BACKGROUND:Although vitamin C has an anti-oxidation role and can promote cell proliferation, there is a lack of research about the promoting effect of vitamin C on the proliferation of adipose-derived stem cells under high glucose conditions and the related molecular mechanisms.OBJECTIVE:To explore the promoting effect of vitamin C on the proliferation adipose-derived stem cells treated by the high glucose and the related molecular mechanisms.METHODS:Passage 3 human adipose-derived stem cells were cultured under high glucose conditions and then treated with different concentrations of vitamin C (0, 100, 150, 200, 250, 300 μmol/L). Cells cultured under low glucose conditions acted as controls. The expression levels of p-ERK and p-AKT proteins were detected by western blot. MTT method was used to choose the optimal concentration and time of vitamin C for all the subsequent tests. Human adipose-derived stem cells cultured under high glucose conditions were divided into four groups, and cells in blank control group had no treatment. Cells in the other three groups were treated with the optimal concentration of vitamin C (vitamin C group), LY294002+the optimal concentration of vitamin C (LY294002 group), or U0126+the optimal concentration of vitamin C (U0126 group) for 48 hours.EdU staining assay was used to detect the cell proliferation of human adipose-derived stem cells.RESULTS AND CONCLUSION:(1) Cell counting kit detection:We found that high glucose reduced the proliferation of human adipose-derived stem cells, and vitamin C promoted the proliferation of these cells. The best concentration of vitamin C was 200 μmol/L and the optimal effect time was 48 hours. (2) Western blot detection:Compared with the 0 μmol/L vitamin C group, the level of p-ERK in the 200 μmol/L vitamin C group was upregulated significantly (P < 0.01),while no significant expression change in p-AKT protein was found in control, 0 and 200 μmol/L vitamin C groups.(3) EdU test:the number of EdU positive cells was significantly higher in the vitamin C, LY294002, and control groups compared with the blank control group (P < 0.01). Moreover, compared with the vitamin C group, the EdU positive cells in the U0126 group were decreased significantly in number (P < 0.01). In conclusion, the ERK/MAPK signaling pathway is involved in the promotion effect of vitamin C on the proliferation of human adipose-derived stem cells under high glucose conditions.

Objective:To study the protective effects of sea buckthorn polysaccharide extracts on lipopolysaccharide( LPS)/D-galactosa mine ( D-GalN )-induced liver injury in mice and investigate the regulation on hepatic TLR4 and SOCS3 expression.Methods:C57BL/6 male mice were randomly divided into six groups:control group,model group,dexamethasone positive control group, low, medium and high dose group of sea buckthorn polysaccharide.Mice in the sea buckthorn polysaccharides low, medium and high dose group were gavaged with 50, 100 and 200 mg/kg sea buckthorn polysaccharide extracts for 14 days respectively.Acute liver injury model were established by intraperitoneal injection of LPS(10 μg/kg) and D-GalN (700 mg/kg).The mice in the dexamethasone positive control group were intraperitoneally injected with dexamethasone (10 mg/kg) before model estab-lishment.Serum and liver samples were collected after model establishment for 4 h .Serum levels of ALT and AST were detected.Histological changes of liver tissue were observed by HE staining.Hepatic expression of TLR4 and SOCS3 was detected by Western blot.Results:Sea buckthorn polysaccharide significantly inhibited LPS/D-GalN-induced elevation in serum levels of ALT and AST.It also alleviated liver cell injury and inflammatory infiltration.Western blot results showed that sea buckthorn polysaccharide inhibited LPS/D-GalN-induced TLR4 expression.SOCS3 expression was not dramatically influenced by sea buckthorn polysaccharide supplementation.Conclusion:Sea buckthorn polysaccharide protects against LPS/D-GalN-induced liver injury.This protective effects may be achieved by inhibiting the expression of TLR4 but not associated with modulation on SOCS3 expression.