Objective To investigate etiologies,treatment approaches and prophylaxis for delayed thoracostomach emptying in esophageal or gastric cardiac cancer patients treated with esophagogastrostomy.Methods We performed a retrospective review of the clinical data of 24 patients suffering delayed thoracostomach emptying among 1985 post-surgical patients with esophageal or gastric cardiac cancer from January 2000 to June 2011.Results Eighteen patients in the 24 patients were cured by conservative managements including endoscopic dilatation procedures.The remaining 6 patients were treated with surgery.Conclusion The main etiology of delayed thoracostomach emptying is gastroparesis,which can be treated with nonsurgical conservative approaches; whereas mechanical emptying disturbance requires surgery.Endoscopic examination appears to be the most important diagnostic approach in identifying and differentiating the etiologies of delayed thoracostomach emptying in post-surgical patients.Endoscopic dilatation procedure is proved to be effective for the treatment of delayed thoracostomach emptying in post-surgical patients in this study.

Objective To explore the diagnosis value of CT in subarachnoid hemorrhage(SAH) induced by aneurysm rupture.Methods The clinical and CT data of 119 patients with SAH induced by aneurysm rupture were analyzed respectively.Results The CT characteristic of SAH induced by aneurysm rupture was full of hyperderse in sulcus and schizenceplay,or accompaning intracerebral hematoma in the straight gyrus of frontal lobe and the hippocampal gyrus of parietal lobe.Conclusion The CT has important value for diagnosing SAH induced by aneurysm rupture in the location and the nature.But it is indispensable that the CTA or DSA must be done for ascertaining the artery of responsibility of rupturing aneurysm.

Objective To investigate the expression of Notch4 protein and to analyze its correlation with the clinical parameters and the microvessel dentisty in renal cell carcinoma. Methods The expression of Notch4 was examined in 60 cases of renal cell carcinoma and the para-carcinoma tissue by SP immunohistochemical stain-ing ,and CD34 detection was used for counting microvessel density. Statistical analysis was performed to reveal the correlation with clinicopathological parameters ,microvessel density and prognosis. Results The positive rate of Notch4 protein expression was 75%(45/60)in para-carcinoma tissue,and was 43.3%(26/60)in renal cell car-cinoma,with significant difference on tumor grade and Lymph node metastasis(P<0.05). The microvessel densi-ty in Notch4 positive tissues was significant lower than that in the negative samples(P<0.05). The survival time of patients with Notch4 positive expression was significantly longer than that of patients with Notch4 negative expres-sion(P<0.05). Conclusion Notch4 protein plays an important role in the development of renal cell carcinoma. Notch4 expression might both attenuate the malignant biological characteristics and suppress the angiogenesis dur-ing tumor development.

Objective To obtain reasonable treatment by urodynamic detection and analysis in patients with diabetic cystopathy (DCP) complicated with benign prostatic hyperplasia (BPH).Methods Sixty patients with DCP complicated with BPH were selected,among the total 32 patients (duration of diabetes ＞ 12 years,blood glucose control was not ideal) were recognized as experimental group,and 28 patients (duration of diabetes ≤ 8 years,blood glucose control was stable) were recognized as control group.Using the Laborie UDS-120XLT urodynamic detection instrument,the urodynamic was detected and the international prostate symptom score (IPSS) was evaluate,and the results were compared between the 2 groups.Results There was no statistical difference in residual urine volume between experimental group and control group [(146 ±71) ml vs.(160 ±64) ml,P ＞0.05].The maximum urinary flow-rate in experimental group was significantly lower than that in control group [(5.4 ± 2.0) ml/s vs.(8.0 ± 3.2) ml/s],the symptom total score of IPSS was significantly higher than that in control group [(25.8 ± 4.1) scores vs.(22.6 ±5.0) scores],there were statistical differences (P ＜0.01).The maximum bladder capacity,compliance,incipient micturition desire volume in experimental group were significantly lower than those in control group,there were statistical differences (P ＜ 0.01).Conclusions The influence of DCP on the function of the bladder in BPH patients is significant.Urodynamic detection can provide objective basis for the selection of therapeutic methods,suitable to be operated and forecast the postoperative effect.It has an important reference value in DCP complicated with BPH patients.

Objective To explore the effects of overexpression of hypoxia inducible factor 1? (HIF 1?) mRNA on vascular endothelial growth factor (VEGF) and novoendotheliasis in venous autografts Methods Wistar rats were randomly divided into two groups with 28 rats in each group A rat experimental model of autogenous vein graft was established by transplanting the right external jugular vein into between the interrupted right common carotid artery The transplanted vein in the experimental group was first immersed into a solution containing recombinant adeno associated virus (rAAV) HIF 1? for 45 minutes Vein grafts and blood simples were taken at 7 or 14 days after transplantation RT PCR, ELISA, immunohistochemistry were used to detected HIF 1? mRNA and VEGF expression Results HIF 1? mRNA and VEGF protein remarkably increased in experimental group, and serum level of E selectin significantly decraesed at day 14 The novoendotheliasis and myo endothelium junction in vein grafts were remodeled at day 14 in the experimental group Conclusion Re establishment of the structure and function of the autograft vein graft endothelium was accelerated by overexpressed HIF 1? mRNA

Objective To analyze the incidence and clinical features of urothelial tumors in renal allograft recipients.Methods A retrospective analysis of 1042 patients received renal allografts who had taken immunosuppression for at least six months between 2006 and 2011 in The First Centre Hospital of Tianjin was performed.Results Eleven cases of uroepithelial tumors were diagnosed in the 1042 cases of renal transplantation ( 1.06％ ),of whom 9 cases were noticed by hematuria ( 81.8 ％ ),2 cases ( 18.2％ ) by medical examination.Six patients were diagnosed with multifocal urothelial carcinomas.Surgery was performed on all the patients with renal tumors and followed by chemotherapy or radiotherapy.Conclusion Malignancies in urinary tract after renal transplantation should be bore in mind.Early diagnosis is very important.The treatment options include reducing immunosuppressive agents and removing tumor lesions completely.

Objective To assess apoptosis mediated by the cell death receptor Fas in peripheral T lymphocytes of patients with abdominal aortic aneurysm. Methods The apoptotic pathway was triggered by anti-Fas monoclonal antibody in cultured and activated peripheral T-cells from 20 AAA patients. Control groups consisted of 15 patients with aortic atherosclerotic occlusive disease(AOD)and 25 healthy individuals. Cell survival and death rate were assessed. Results Cross-linkage of Fas receptor exerted a strong apoptotic response on T cells from AOD patients and healthy controls, while the effect on T cells was very limited from that of AAA patients. The evaluation of cell Survival rate showed a significantly higher percentage in AAA group(98.9%±10.3%)than in the AOD subjects(58.9%±15.2%)or the healthy group(59.4%±12.9%;P＜0.001＝.Apoptosis assessment by annexin V and propidium iodide staining and flow cytometry showed similar results. The defect in AAA group was not due to decreased fas expressed at normal levels. Moreover,it specifically involved the Fas system because cell death was induced in the normal way by methylprednisolone. Conclusions Fas-induced apoptosis in activated T cell from AAA patients is impaired. This may disturb the normal down-regulation of the immune response and thus provide a new insight into possible mechanisms and routes in the pathogenesis of AAA.

Objetctive To summarize the associated complications with circulatory support device,and provide reference for chnical practice.Method A total of 8306 consecutive patients who underwent open heart surgery,in Department of Post-operation Intensive Care Unit of the Cardiac Surgery,Anzhen Hospital,Capital Medical University,was retrospectively studied from January 2005 to February 2007.And the clinical data of 246 patients including 63 female and 183 male patients with mean age 56.7±14.2 years supported with various circulatory support devices for perioperative cardiorespiratory function failure in ICU were analyzed.Left ventricular assist device (LVAD) was used in 3 patients by the cannulation of the left alritan and ascending aorta.The extracorporeal membrane oxygenation(ECMO) was established in 48 patients for postoperative cardiorespiratory function failure.The vencarterial bypass was established by cannulation of the right atrium in 41 patients and femoral artery and of venovenons in 2 patients,and of the right atrium and ascending aorta in 5 cases,lntra-aortic balloon pumping(I-ABP)was performed via the femoral artery either percutaneonsly by the Seldinger technique in 195 patients.The cardiac operations included coronary artery bypass grafting (n=170),coronary artery bypass grafting with romoldingof left ventricle (n = 22),coronary artery bypass grafting with valvular operation (n=10),valvular operation (n=27),heart transplantation(n=8),correction of congenital heart defects(n=6),aortic operations(n=2).The duration of circulatory support ranged from 4 to 451 hours.Correlative complications of 3 kinds of circulatory support device were compared and repair of ventricular septal perforation in the wake of acute myocardial infarction (n=1).Results Seventy-eight (31.7%) patients died.Seventy-one(28.9% ) patients devdoped various complications including infection(n=27),renal failure required renal rephcement therapy (n=27),re-exploration for bleeding(n=24),haemolysis(n=6),limb ischemia(n=15),neurological complications(n=6),oxygenator failure(n=7) Conchusions The improvement of management to reduce complications may result in improved outcomes of patients supported with circulatory support devices.

Objective Extracorporeal membrane oxygenation (ECMO) provides a treatment for patients with acute heart-lung failure. However, as an invasive procedure, it associated with high incidence of complications. It is important to a-vert and reduce the complications for improving the success rate in critically ill patients. We investigate the complications associated with ECMO after cardiac surgery and their management. Methods Clinical data from 117 postoperative patients[32 male, mean age (48.7 ± 16.5) years]supported with ECMO in the cardiovascular intensive care unit( ICU) from March 2005 to June 2008 were analyzed retrospectively. The cardiac operations they had undergone included coronary artery bypass grafting (n = 20), coronary artery bypass grafting and remodeling of left ventricle(n =9), coronary artery bypass grafting and valvular operation(n =5), repair of ventricular septal perforation following acute myocardial infarction(n =2), valvular operation( n = 46), heart/lung transplantation (n = 20/1), correction of congenital heart defects ( n = 10), and aortic operations ( n = 4). Venoarterial bypass was established in 110 patients by cannulation of the right atrium and femoral artery, and that of the right atrium and ascending aorta in 5 cases. Left atrial drainage to ECMO was added in 2 cases. Venovenous bypass was established in 2 patients with hypoxemia following cardiac surgery. Heparin was infused for maintaining the activated coagulation time (ACT) at 160 to 200 seconds for centrifugal pump(114 cases),and 200 to 250 seconds for roller pump(3 cases) to avoid thrombotic events until decannulation was achieved. Results The mean ECMO duration was 61 hours (range 3 to 225 hours). 48(41.0% ) patients died, 18 of them died of complications after weaning from circulatory assistant successfully. Complications occurred in 74 (63.2% ) patients included reoperation for hemostasis (n = 24), renal failure requiring renal replacement therapy (n =29), nosocomial infections ( n = 32) , ischemia in the extremities(n = 5), plasma leakage of oxygenators ( n = 29), gastroenteral hemorrhage ( n = 14), hemolysis ( n = 7 ), neurological complications ( n = 4) and centrifugal pump failure (n =1). Conclusion Bleeding is an early complication associated with ECMO support. The risk of nosocomial infection, renal failure and plasma leakage of oxygenators increases with the duration of ECMO support.

ObjectiveTo investigate the expression and significance of p38 mitogen-activated protei n kinase (MAPK) in autogenous vein graft. Methods Autogenous vein graft model was established by transplanting the right jugular vein to infr arenal abdominal aorta in 80 Wistar rats. Ten vein graft samples were harvested 6 hours, 24 hours, 3 days, 7 days, 2 weeks, 4 weeks, 6 weeks and 8 weeks after s urgery,respectively. Reverse transcription-PCR and in situ hybridization,Wester n blot and immunohistochemistry methods were used to detect the expression of pr otein and phosphorylation protein of p38 and p38mRNA. ResultsThe expression of p38 mRNA increased 6 hours after surgery and reached the peak on the second week after surgery (59%?26%),and significantly higher than that on 4,6,8 weeks( P