Objective To discuss the clinical application and features of coronary artery bypass grafting(CABG) through left intercostal thoracotomy approach. Methods A total of 36 cases of CABG were performed through left intercostal thoracotomy approach from September 1996 to August 2005 in this hospital.The patients fell into four categories: ①single vessel disease in the left anterior descending artery(LAD);②re-operation of CABG with a patent LIMA(left internal mammary artery)-LAD bypass;③severe calcified ascending aorta;and ④concurrent other procedures that required left thoracotomy.There were 26 cases of single vessel disease,3 cases of double vessel disease,and 7 cases of triple vessel disease.Five cases had a history of percutaneous coronary interventions(PCIs) and 6 cases had a history of CABGs.The left ventricular ejection fraction was 0.562?0.107. Results Off pump CABG with 1~4 distal anastomosis was successfully accomplished in all the 36 cases,with an operation time of 190.4?44.1 min.Concurrent procedures included 2 cases of transmyocardial laser revascularization(TMLR),1 case of lung cancer resection,and 1 case of esophageal cancer resection.There was no in-hospital mortality.Two fatal cases were seen in long-term follow-up observations.Recurrent angina developed in 2 cases 1 year after operation,and was cured with a PCI in 1 case and with a re-operation of CABG in 1 case. Conclusions The left intercostal thoracotomy is a safe and feasible approach for CABG surgery in patients with some special types of coronary heart disease.The procedure can be performed under beating heart.

Objective To report the experience of first 100 cases of off-pump coronary artery bypass(OPCAB) grafting by a training cardiac surgeon,and to discuss the feasibility of the training method.Methods The trainee,who had no previous experience of coronary surgery,received an OPCAB training program under the guidance by a director who had completed more than 2000 cases OPCAB.After 28 months of training,the trainee began to be an independent operator.The data of the first consecutive 100 cases of OPCAB by the trainee(Training Group) were collected for comparison with the director's 100 cases of OPCAB surgery(Control Group).Results There were 5 cases of conversion to on-pump surgery in the Training Group.The number of distal anastmosis in the Training Group(2.9?0.6) was smaller than that in the Control Group(3.5?0.7)(t=-6.508,P=0.001).Compared with the Control Group,there were less circumflex grafts(67/100 vs 88/100;?~2=12.645,P=0.000) and sequential grafts(3/100 vs 27/100;?~2=22.588,P=0.000) in the Training Group.There was no significant difference in mortality between the Training Group(3%,3 cases) and the Control Group(1%,1 case)(?~2=0.255,P=0.614).No significant difference was observed between the two groups in other postoperative severe complications.Conclusions The first 100 cases of OPCAB surgery performed by the trainee give favorable results,indicating a stable transition from training period to independent performance.It also testifies the feasibility of this training program.

Objective To analyzed the clinical features,laboratory examination and sacroiliac joint CT signs of ankylosing spondylitis.Methods Of all 22 cases,20 were male,2 were female,the age ranges from 14 to 70 with average of 27.9.All patients accepted spiral CT axial scan of sacoiliac joint,their prominent clinical features and laboratory examination were registered.Results Hip pain,waist pain and lmitation of stoop were outstanding clinical features,their proportions were 63.3%,40.9%,31.8% respectively.Laboratory exanination:positive rates of HLA-B 27 and RF were respectively 100%,27.2%.Percentages of ESR speeding and CRP increasing were respectively 90.9%,31.8%.Among all CT signs,coarseness,dimness and erosion of SI joint had the highest percentage(68.1%).Others,such as osteosclerosis was in 50%,joint narrowing was in 36.3%,joint union was in 9.1%.Conclusion In patients with ankylosing spondyeitis, hip pain is common clinical feature.Positive HLA-B 27 ,mcreasing of ESR and CRP are valuable for diagnosis.SI joint CT examination often demonstrates joint coraseness,dimness and erosion.

Objective To analyze the color Doppler ultrasonography of trauma-caused deep venous free-floating thrombus(FFT)of lower limbs,discuss the relations between sonography and the prognosis. Methods Clinical data and color Doppler ultrasound examination results of 130 cases with trauma-caused deep venous FFT of lower limbs were retrospectively analysed.Univariate analysis was conducted to identify the statistically significant factors of patients' prognosis,non-conditional logistic regression analysis was performed to analyse the independent prognostic factors of FFT.Results The non-conditional logistic regression analysis showed that the position of FFT,thrombosis edge definition,floating degree and the volume of detouring blood around the thrombus were independent factors of patients'prognosis(P <0.05). The FFT prognosis of iliofemoral vein was more likely to be fixed than the FFT prognosis of popliteal vein. The FFT prognosis with blurring edges was more likely to be fixed.The more obvious the floating degree of FFT,the higher chance that the FFT prognosis is recanalized.More detouring blood flow around FFT indicated more possibilities that the prognosis could be recanalized.Conclusions The color Doppler ultrasound is able to evaluate the relations between the deep venous free-floating thrombus of lower limbs and prognosis of the patients,which is beneficial for early detection and early treatment,as well as reducing mortality and disability resulted from deep venous thrombus during the orthopaedic perioperative period.

[Objective] The aim of this study is to investigate the mechanism and curative effect of cataplasma of Artemisia Argyi by supercritical CO 2 fluid extraction to rat weight, foot swel ing, interleukin-1β, interleukin-17 and tumor necrosis factor-αin the adjuvant arthritis rat models;and afford theoreti-cal evidence for clinical work.[Methods]50 healthy male SD rats were randomly divided into 5 groups:Control group, Model group, Low-dose treatment group, Medium-dose treatment group, High-dose treatment group. Model and al treatment goups took CFA for model ing. After establishing animal models of AA rats, the first group and second group used cataplasm without active drug ingredients. Other groups were given treatment according to dif-ferent drug doses. Assess the joint swel ing degree at different times. Measure the arthritic index and rat weight in two weeks. After 21 days ,detect the cy-tokines level of IL-lβ,IL-17 and TNF-α from the rat's serum and examine the pathological changes of joint observed by HE . [Results]Cataplasma of Artemisia Argyi by supercritical CO2 fluid extraction can significantly reduce rat foot swel ing of the ankle joint pathology ,reduce arthritis score and slow down the weight loss,meanwhile,effectively improve the general daily behavior of rats. The standard of IL-1β,IL-17,TNF-α in serum can be decreased by cataplasma of Artemisia Argyi by supercritical CO2 fluid extraction. The pathological result showed: in the treatment group,the rats synovial hyperplasia the vesselwing reduced, the inflammatory cel infiltration was more decreased than the model group. [Conclusion]The result showed that the cataplasma of Artemisia Argyi by supercritical CO2 fluid extraction had an obvious effect in treating RA. The mechanism was probably that it regulated the immune dis-order of RA.

Objective To research the diagnosis and treatment of acute biliary pancreatitis(ABP).Methods The clinical data of 79 rases with ABP were retrospectively analyzed.Results Among 17 non-operation patients,1 died;62 cases were operated,died 8 and cure 54 cases.Conclusion Early emergency operation should be performed for relief of biliary obstruction in acute biliary obstructive pancreatitis.The patients with acute non-obstructive biliary pancreatitis should undergo conservative therapy at first and then,after pancreatitis has been controlled,delayed operation or selective operation to treat the biliary pathologic condition should be performed.

Objective To explore the correlation factors of hospital stay and hospitalization costs among patients with acute ischemia stroke (AIS). Methods The clinical data of the patients with first diagnosis of AIS at Peking University Third Hospital in China from January 1 , 2012 to December 31 , 2012 were retrospectively analyzed to investigate the correlation factors of hospital stay and hospitalization costs using univariate analysis and multiple regression analysis. Results The study involved 496 patients, with a mean age of 63.38 years (range:26~88 years). Multivariate regression analysis showed the significant impact factors for LOS were age, pneumonia, the total score on NIHSS, medication for secondary prevention and stroke subtype. The significant impact factors for cost of hospital stay were payment method, stroke subtype, age, the total score on NIHSS and medication for secondary prevention. Conclusions Age, pneumonia, the total score on NIHSS, stroke treatment and its subtypes are the significant impact factors affecting hospital stay. Payment method, stroke subtype, age, the total score on NIHSS and medication for secondary prevention are the significant impact factors affecting costs of hospitalization.

Objective: To observe the protective effect of ligustrazine on myocardial ischemia rat induced by isoproterenol. Methods : The model of myocardial ischemia was induced by subtcuaneous injection of isoproterenol (ISP, 5mg?kg -1 ) into rats and repeated the same dose 24 hours later. The activities of Ca 2+ -ATPase、Ca 2+ -Mg 2+ -ATPase and the contents of Ca 2+ in the myocardial mitochondria were observed, respectively. The changes of protein expression of bcl-2 and bax genes were detected by immunohistochemical staining. Results : In the ligustrazine treated group, as compared with those of the model, the activities of Ca 2+ -ATPase、Ca 2+ -Mg 2+ -ATPase in the myocardial mitochondria increased significantly( P 0.05). Conclusion : Ligustrazine possesses protective effects against myocardial ischemia injury via increasing the activities of Ca 2+ -ATPase、Ca 2+ -Mg 2+ -ATPase in the myocardial mitochondria and influencing the expression of bcl-2.

Objective To construct an X-gene defect and IFN gene contained HBV expression plasmid and explore its expression effect in HepG2 cell line. Methods By employing pBR322-B-HBV plasmid which contained type adrⅠHBV DNA, we destroyed HBV X-gene by inserting mutation and connected the defect HBV with IFN sequence. After recombination, it was introduced into a mammalian plasmid and was constructed as the objective plasmid. At the same time, two control groups were constructed. One was pcDNA3-ES-HBV2, which contained the full length of HBV DNA. The other was pcDNA3-KN-F1F2, which contained the X-gene defect HBV DNA. Then we transfected HepG2 cells with all the plasmid. After the cells were screened by G418, the X-gene defect and IFN gene contained HBV(KN-F1F2-IFN) and IFN protein from culture medium were detected by fluorescence- quantitative-PCR and ELISA respectively. Results pcDNA3-KN-F1F2-IFN, as the objective plasmid, was constructed successfully; contrary with the control virus, the amounts of both HBV and HBsAg were lower; both IFN mRNA and IFN protein were detected.Conclusions An X-gene defect and IFN gene contained HBV expression plasmid was constructed successfully and it can be expressed in HepG2 cell line.

Objective:To determine the effect of standardized patients in medical international students' graduation practice assessment.Methods:The students were divided into two groups ofstandardized patient assessment and traditional assessment,the theoretical and professional performance was compared and analyzed after the assessments.All the students were investigated using questionnaire.Result:The students assessed using standardized patients reported higher skill scores than those with traditional assessments,and the difference was statistically significant.However,no difference was observed in theoretical scores.Gorcltusion:The introduction of standardized patient to medical international students' graduation practice assessment alleviates the status that emphasizes theory but ignores practice due to the lack of clinical resources,eliminates the obstacles in the communication between students and patients,and is conducive to the cultivation of humanistic quality and adaptability of the students.It is worthy popularizing in international students' graduation practice assessment.