Objective To study the effectiveness of subfascial endoscopic communicating branch vein ablation in treating communi cating branch vein insufficiency.Methods Fifty-seven cases of primary lower ext remity vein valve insufficiency complicated by communicating vein insufficiency diagnosed by venography and color duplex were treated with subfascial endoscopic communicating branch vein ablation, and their information was analyzed retrosp ectively.Results Swelling was observed in leg of 7 cases after operation, and disappeared within one week spontaneously. Incision infec tion occurred in 2 cases and skin ambustion happened in 2 cases. Superficial vei n varicosis disappeared in all case, skin pigmentatin declined significantly and ulcers healed in 2-3 weeks.Conclusion Subfascial endoscopic communicating branch vein ablation is an excellent choice in treating communicating branch ve in insufficiency.

AIM: Recent studies showed that stem cells could replace injured cardiomyocyte and increase the number of functional cardiomyocytes. Researching the pertinent literature in China Journal Full-text Database (CJFD) published between 2005 and 2008 indicated that the researches on stem cell transplantation in the treatment of primary dilated cardiomyopathy were few. This study investigated the therapeutic efficacy and security of peripheral blood stem cell transplantation in coronary artery in treatment of dilated cardiomyopathy and its effects on left ventricular function. METHODS: Forty-two patients with dilated cardiomyopathy between December 2006 and September 2007 were enrolled at the Department of Cardiology of First People's Hospital of Yunnan, including twenty-eight males and fourteen females, averagely aged (56?3) years. Inclusive criteria: patients with less than 65 years, left ventricular enlargement, and left ventricular ejection fraction (LVEF) ≤ 45%, and without coronary artery disease after coronary arteriongraphy. Informed consents were obtained from patients. Patients were divided into stem cell transplantation group (n=15) and control group (n=27) on the basis of whether being treated by stem cell transplantation. Patients in the stem cell transplantation group were consecutively administered granulocyte colony-stimulating factor (G-CSF) by hypodermic injection to stimulate bone marrow stem cells themselves based on conventional treatment for five days. Peripheral blood stem cell suspension was disassociated on the 6th day, and the collected suspension was injected into left anterior descending branch over the wire saccule tube for autologous peripheral blood stem cell transplantation. Patients in the control group were administered by conventional treatment of dilated cardiomyopathy. Security and adverse reaction were observed during the mobilization, collection and returning injection of peripheral blood stem cell by coronary artery. Morphous, cardiac function and motion index of left ventricle wall were evaluated using ultrasoundcardiogram before and 3 months after transplantation. Survival rate and incidence rate of heart incidents were compared. RESULTS: Three months after stem cell transplantation in coronary artery, there were a significant decrease in cardiac end-systolic volume (ESV), cardiac end-diastolic volume (EDV) and motion index of left ventricle wall, but a significant increase in LVEF(P

Objective: To analyze the long-term prognosis of re-operation in patients with functional tricuspid regurgitation (FTR) after left sided valve replacement (LSVR) and hence evaluate the optimal timing of mentioned re-operation. Methods: A total of 59 FTR patients who had re-operation after their prior LSVR in our hospital from 1999-01 to 2013-01 were analyzed. The clinical information and post-operative follow-up results were recorded in all patients. Results: There were 5/59 (8.5%) patients died in peri-operative period and the overall post-operative mortality was 11.9% (7/59). The follow-up data of 54 survivors were available for the mean time of 51.1 (21-188) months. There were 19/54 (35.2%) patients suffered from MACE and 30 (55.6%) were beneifted by improved cardiac function. Uni-variable analysis indicated that pre-operative NYHA class IV (P=0.008), pre-operative right ventricular (RV) dysfunction (P=0.037), concomitant left-sided redo-operation (P=0.017) and TVR operation (P=0.002) were associated with all cause mortality of tricuspid re-operation. Multi-variable Cox regression analysis showed that pre-operative RV dysfunction was the only independent risk factor of long term MACE-free accumulating survival rate (HR=3.0, 95% CI 1.11-8.2,P=0.031); while TVR operation (HR=12.8, 95% CI 1.53-107.02,P=0.019) and pre-operative NYHA class IV (HR=5.3, 95% CI 1.20-24.51,P=0.032) were the independent risk factors for long-term mortality in patients after tricuspid re-operation. Conclusion: Patients with compensatory RV function showed better long term prognosis after secondary tricuspid operation. Aggressive re-operation before the occurrence of right ventricular dysfunction could be beneficial for relevant patients.

Objective To analyze the risk factors of emergence agitation (EA)in the adult patients during the recovery peri-od after general anesthesia in postanesthesia care unit(PACU).Methods 2 056 adult patients undergoing elective surgery under general anesthesia in PACU were selected,aged more than 18 years old,sex unlimited The following factors of age,gender,body mass,ASA grade,preoperative combined disease,education level,premedicatiou,general anesthesia mode,midazolam use for induc-tion,anesthesia time,operation site,operation mode,operation time,intraoperative blood loss,intraoperative fluid replacement,re-covery time in PACU,body temperature,urinary catheter,urine volume,etc.were recorded.According to whether EA occurring during recovery from general anesthesia,the patients were divided into the quiet group and the EA group.The multivariate Logistic regression was performed to analyze and screen the risk factors for the occurrence of EA.Results 127 cases developed EA during recovery from anesthesia.The occurrence rate of EA was 6.18%.The Logistic regression analysis indicated that high grade ASA, large quantity of intraoperative fluid replacement,placing urinary catheter and postoperative pain were the risk factors for EA(P <0.05).Conclusion Highgrade ASA,large quantity of intraoperative fluid replacement,placing urinary catheter and postoperative pain are the risk factors for EA during the recovery period after general anesthesia in PACU.

Objective To clarify the effect of Fogarty balloon catheter thrombectomy on venous wall integraty when performed on different time phases.MethodsA murine model of inferior vena caval thrombosis was established. Collagen of venous wall was measured by Van Gieson staining and this was used as the criteria of venous wall injury. The thrombus residue was determined after Fogarty balloon catheter thrombectomy in each individual time phase. Results Collagen deposit in the adventitia of venous wall increased every day,to an amount of (5 902?399) ?m2 on the third day which was significantly different from that of controls (5 333?454) ?m2(P

OBJECTIVETo study the relationship between peripheral blood hepatocellular carcinoma cells-associated AFP mRNA and tumor relapse and metastasis.

METHODSTo detect several blood samples from the HCC patients by nested RT-PCR to find out AFP mRNA after 24 h, 72 h and one week and 4 weeks after surgery, and followed up the HCC patients for 1, 2, 3 years.

RESULTSThere were 7 patients occurred relapse or distant metastasis in 12 patients with AFP mRNA positive (7/12, 58.3%), there were 5 patients occurred relapse in 19 patients with AFP mRNA negative (5/19, 26.3%) within 1 year, there was 4 patients occurred relapse in second year (9/19, 47.3%); 5 patients occurred relapse in third year (10/19, 52.6%). Obvious connection between patients AFP mRNA positive and AFP mRNA negative was observed (P < 0.01).

CONCLUSIONSHCC with AFP mRNA positive has more change to be recurrent compared with HCC patients with AFP mRNA negative.

Adult ; Carcinoma, Hepatocellular ; blood ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; blood ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplastic Cells, Circulating ; Postoperative Period ; RNA, Messenger ; blood ; alpha-Fetoproteins ; genetics ; metabolism

BACKGROUND: The association of genetic variation in the IRAK-1 gene with sepsis outcome has been proved. However, few studies have addressed the impact of the IRAK-4 gene variants on sepsis risk. This study aimed to determine whether the polymorphisms in the IRAK-4 gene are associated with susceptibility to and prognosis of severe sepsis in the Chinese Han ethnic population.METHODS: In this case-control study, 192 patients with severe sepsis hospitalized in the emergency department of Zhongshan Hospital from February 2006 to December 2009 and 192 healthy volunteers were enrolled. Exclusion criteria included metastatic tumors, autoimmune diseases, AIDS or treatment with immunosuppressive drugs. This study was approved by the ethical committee of Zhongshan Hospital, Fudan University. Sepsis patients were divided into a survival group (n=124) and a non-survival group (n=68) according to the 30-day mortality. Primer 3 software was used to design PCR and sequencing primers. Genomic DNA was extracted from peripheral blood mononuclear cells. Seven tagSNPs in IRAK-4 were selected according to the data of the Chinese Han population in Beijing from the Hapmap project and genotyped by direct sequencing. The chi-square test was used to evaluate the differences in genotype and allele frequencies between the two groups.RESULTS: The distributions of all tagSNPs were consistent with Hardy-Weinberg equilibrium. The allele and genotype frequencies of rs4251545 (G/A) were significantly different between the severe sepsis and healthy control groups (P=0.015, P=0.035, respectively). Carriers of the rs4251545A had a higher risk for severe sepsis compared with carriers of the rs4251545G (OR=1.69, 95％ CI: 1.10-2.58). The allele and genotype frequencies of all SNPs were not significantly different between the survival group and non-survival group.CONCLUSION: These findings indicate that the variants in IRAK-4 are significantly associated with susceptibility to severe sepsis in the Chinese Han ethnic population.

OBJECTIVETo evaluating the effect of different levels of blood glucose control on inflammatory response and prognosis of the patients in surgical intensive care unit (SICU).

METHODSOne hundred and eighty-eight patients admitted to SICU were randomly divided into three groups, blood glucose were controlled by insulin infusion. Group A (75 cases): the mean blood glucose (MBG) was maintained at the level of 4.4 - 6.1 mmol/L. Group B (75 cases): MBG was maintained at the level of 6.7 - 8.3 mmol/L. Group C (38 cases): MBG was maintained at the level of 10.0 - 11.1 mmol/L. Blood glucose control was achieved with an effected computerized protocol. The outcome was evaluated by days in ICU, days to wean mechanical ventilation, infection, amount of red blood cell transfusion, hospital mortality and ICU cost.

RESULTSCompared with other groups, hypoglycemia (< 3.3 mmol/L) in Group A was significantly increased (P < 0.05). Compared with Group C, red blood cell transfusion and infection were significantly reduced in Group A and Group B (P < 0.05). Compared with Group C, days of mechanical ventilation and days in ICU in Group A were significantly reduced (P < 0.05). Hospital mortality and ICU cost were reduced in Group A compared with the other groups (P > 0.05).

CONCLUSIONSTo maintain blood glucose in normal range with intensive insulin therapy has potential positive impact on SICU patients' outcome and can reduce days in ICU and ICU cost. Further correlation research is needed to determine the best levels of blood glucose in ICU patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Glucose ; metabolism ; Critical Illness ; Female ; Humans ; Hypoglycemic Agents ; administration & dosage ; therapeutic use ; Inflammation ; blood ; etiology ; prevention & control ; Insulin ; administration & dosage ; therapeutic use ; Insulin Infusion Systems ; Intensive Care Units ; Male ; Middle Aged ; Postoperative Care ; methods ; Postoperative Complications ; blood ; etiology ; prevention & control ; Prognosis ; Treatment Outcome

Objective To observe protective effects on rat serum cardiac enzymes and the antioxidant capacity of selenium and vitamin E.Methods According to body weight and 2 × 2 factorial design,eighty male Wistas rats were randomly divided into four groups:low selenium and low vitamin E group(feed containing 23.42％ of the low selenium yeast,excluding vitamin E),low selenium and adequate vitamin E group (feed containing 23.42％ of the low selenium yeast and vitamin E 160 mg/kg),adequate selenium and low vitamin E group(feed containing 46.84％ of the low selenium yeast and sodium seleni 0.25 mg/L in water,excluding vitamin E),adequate selenium and adequate vitamin E group(feed containing 46.84％ of the low selenium yeast,vitamin E 160 mg/kg and sodium selenite 0.25 mg/L in water),20 rats every group.Rats were feed with synthetic feed,and given intraperitoneal anesthesia after 26 weeks of feeding.Blood was collected to observe the impact of selenium and vitamin E on rat cardiac enzymes and myocardial antioxidant capacity and their interactions.Serum creatine kinase (CK) was measured using the continuous monitoring method,creatine kinase isozymes (CK-MB) and lactate dehydrogenase(LDH ) using the immune suppression method,the whole blood GSH-Px assay using the dithiobis nitrohenzoic acid(DTNB) method,serum superoxide dismutase(SOD) using the xanthine oxidase method,total antioxidant capacity (T-AOC) using the complex colorimetry method,the content of propylene glycol (MDA) using the thiobarbituric acid colorimetric method,and reactive oxygen species(ROS) using the colorimetric method.Results Group differences of serum CK,CK-MB,LDH,whole blood GSH-Px activity,serum T-AOC vitality,MDA and ROS content were statistically significant(F=9.797,17.041,48.399,3.744,224.900,49.384,5.045,all P＜ 0.05).Compared with the two low selenium groups and one adequate selenium group,the vitalities of CK,CK-MB,LDH and the contents of MDA[(1577.75 ± 451.87),(1239.15 ± 344.99),(884.25 ± 133.84)U/L,(5.688 ±1.169) × 103 nmol/L; (1474.21 ± 398.38),(1014.84 ± 215.40),(523.00 ± 98.05)U/L,(4.035 ± 0.487 ) × 103 nmol/L and (1180.10 ± 245.51),(948.75 ± 173.68),(676.70 ± 193.63)U/L,(3.406 ± 0.146) × 103 nmol/L]increased significantly in adequate selenium and adequate vitamin E group[( 1056.80 ± 250.98),(721.70 ±129.98),(404.65 ± 72.49)U/L,(3.010 ± 1.270) × 103 nmol/L,all P ＜ 0.05) ].The activity of GSH-Px was obviously increased in the two adequate selenium groups[ (96.611 ± 8.238) × 103,(103.024 ± 8.217) × 103 U/L,all P ＜ 0.05],compared with the two low selenium groups[ (60.356 ± 8.179) × 103,(63.117 ± 8.281) × 103 U/L].Selenium affected the activities of CK,CK-MB and LDH(F =27.09,31.58,29.66,all P＜ 0.01 ),and vitamin E affected the activities of CK-MB and LDH(F=18.9,11.2.all P＜ 0.01 ),but both selenium and vitamin E had no interactions on the activities of CK,CK-MB and LDH (F=0.02,0.001,2.22,all P＞0.05).Selenium affected the activity of GSH-Px and the content of MDA(F=6.74,95.68,all P＜ 0.05),vitamin E affected the activity of T-AOC,the contents of MDA and ROS(F=6.42,36.73,8.43,all P＜0.05),but selenium and vitamin E had interactions only on the content of MDA(F =13.82,P＜ 0.05).Conclusions Long-term selenium or vitamin E deficiency,can reduce the body's antioxidant capacity,leading to the occurrence of myocardial injury.Selenium and vitamin E can improve the body's oxidation capacity,playing a role in myocardial protection.

Objective To explore standardized continuing vascular ultrasound training in China.Methods Data of current ultrasound practitioner education levels in the secondary and tertiary hospitals were collected.Under the direction of the Chinese Ultrasound Doctor Association (CUDA),Vascular Ultrasound Guidelines were introduced.The CUDA Steering Committee for Standardized Vascular Ultrasound Training and Vascular Ultrasound Training Centers were established.Results The questionnaires were received from 182 ultrasound departments of 57 secondary hospitals and 125 tertiary hospitals.The proportion of ultrasound practitioners who obtained a university degree was significantly higher in the ultrasound departments of tertiary hospitals than that in the secondary hospitals (75.18% vs 52.63%).The proportion of ultrasound practitioners who only received short-term ultrasound training and did not have tertiary education was significantly higher in the ultrasound departments of secondary hospitals than that in the tertiary hospitals (8.31% vs 1.03%).The directors of ultrasound departments in both secondary and tertiary hospitals believed that ultrasound practitioners should at least have a university diploma and preferably have a university degree.The CUDA and the American Registry for Diagnostic Medical Sonography (ARDMS) co-hosted two standardized vascular ultrasound training seminars and the first Registered Physician in Vascular Interpretation (RPVI) credential examination in Beijing.A well-known vascular ultrasound reference book,Introduction to Vascular Ultrasound was translated from English into Chinese and published in September 2008.The CUDA Vascular Ultrasound Guidelines were drafted by 12 vascular ultrasound experts from China,U.S.and Australia,which were widely discussed and passed by the CUDA Standing Committee.The guidelines have been published in the Chinese Journal of Ultrasonography and on the website of CUDA (www.cuda.org.cn).The CUDA has signed a publishing contract with a medical press to publish the guideline booklet.The CUDA Steering Committee for the Standardized Vascular Ultrasound Training was established which includes 24 domestic and foreign experts.The CUDA Standardized Vascular Ultrasound Training Centers were awarded to 12 hospitals,which were selected,trained and assessed by the CUDA from 35 candidates.Each center is expected to undertake one to two standardized vascular ultrasound training courses each year.Conclusion Continuing education of vascular ultrasound introduced by CUDA has been accepted positively by a portion of Chinese doctors with ultrasound major.