The author analyzed a contradictory between medical and health sevrice under market economic and standardized medical moral that the patient is urge to hope.The paper further proposed medical establishment and medical staff should regard honest and credit as a basic service reguest to pracice in oroler to win the pafient and other people's confidence.

Objective　To determine the changes of serum IL-10 level in perioperative period in patients with hepatocellular carcinoma (HCC) and discuss its significance. Methods　The serum IL-10 level was determined with ELISA in 30 patients with HCC and 30 healthy volunteers. Results　The serum IL-10 level was significantly higher in the perioperative period in patients with HCC than in the healthy volunteers. In the patients with HCC, the level was higher before than after the operation. Meanwhile, it was markedly higher in patients with poorly differentiated tumor or the tumor with a diameter over 5 cm than in those with well-differentiated tumor or the tumor with a diameter less than 5 cm (P<0.01). Conclusion　HCC cells might produce IL-10 that may participate in immune response of HCC. Furthermore, IL-10 might be a factor that can reflect the differentiation grade, assess the prognosis and predict recurrence of HCC.

BACKGROUND: Some scholars have used finite element analysis to simulate spinal biodynamics. But there are few reports on finite element imitation of lumbar biodynamics system before and after artificial disc replacement. OBJECTIVE: This study aimed to do finite element analysis by establishing new three dimensional finite element models of SB-Chaite Ⅲ lumbar disc replacement. DESIGN, TIME AND SETTING: The observational experiments were performed at the Laboratory of Orthopaedics of Xiangya Hospital of Central South University from December 2003 to August 2004. PARTICIPANT: A healthy male volunteer served as simulation. His T12-S1 underwent continuous CT scanning. There were altogether 264 images with 2 mm in thickness each. Three-dimensional images were reconstructed every 15? in order to obtain the data for three-dimensional model. METHODS: The CT images and human anatomical data were processed by 3DSMAX software to establish three-dimensional L4-5 model of normal Chinese males. MAIN OUTCOME MEASURES: It was transformed to finite element model after processed by SAP2000 software together with SB-Chaite Ⅲ disc prosthesis model. RESULTS: The three-dimensional model and finite element model of lumbar spine were successfully established. The finite element model of SB-Chaite Ⅲ disc replacement in L4-5 spine was established. The total nodes were 2 542, including 1 924 Solid units, 592 Area units and 50 Link units. CONCLUSION: The finite element model of artificial disc replacement can be established by CT scanning, digital processor and computer aided design.

Objective To evaluate the safety aod efficacy of device closure of ventricular septal defect (VSD) through parasternal approach,and to compare the advantages and disadvantages of three approaches.Methods Between Jan 2012 and Jul 2015,209 cases(Group A) underwent per-ventricular device closure of VSD through a left parasternal approach,and 36 cases(Group B) underwent per-atrial device closure of VSD through a fight parasternal approach,and 49 cases(Group C) underwent per-ventricular device closure of VSD through a median sternotomy approach.In group A,a 1.0 to 2.0 cm left parasternal iucision was made in the fourth or third intercostal space.Press the right ventricular(RV) free wall to select the puncture point.After securing double purse-string suture around the optimal puncture site,the occluder was introduced via a sheath inserted directly into the RV and navigation and positioning of the device guided by transesophageal echocardiography(TEE).In group B,a 1.0 to 2.0 cm right parasternal incision was made in the fourth or third intercostal space.After securing double purse-string suture at the right atrium near the atrioventricular groove,a specially designed hollow probe was inserted into the right atrium and was passed through the tricuspid valve into the right ventricle.The tip of the probe was manipulated to aim at or cross VSD,and a spring guide-wire was inserted into the left veotricle(LV) through the channel of the probe under TEE guidance.Then the delivery sheath was positioned into LV passing over the wire,and the device was pushed into the sheath and was deployed to finish closure.In group C,after a 1.5 to 3.0 cm median sternal incision was made,the closure of VSD was finished as the same procedure as in group A.Results There was no significant differences at the age and weight between 3 groups,as well as the size of VSD and devices.But the position of VSD varied between 3 groups.The rate of successful closure in group A (98.1％,205/209) and B (97.2％,35/36) was similar to group C (97.9％,48/49).The mean intracardiac manipulating time was shorter in group A(10 ± 6) min and group C (7 ± 5) min than in group B(19 ± 11) min.The mean time of skin cut to suture was shorter in group A(40 ± 15) min and group B(43 ± 17) min than in group C(55 ±21) min.And the average hospitalization time in group A (5.9 ± 2.2) days and group B (5.5 ± 2.7) days was shorter than in group C (8.3 ± 3.6) days.During the follow-up period of 1 to 40 months,no obvious residual leakage,arrhythmia or valvular inadequacy were found in all cases,and no device dropped out.Conclusion Minimally invasive technique of device closure of VSD through parasternal approach appears to be safe and effective,further reducing trauma and recovering faster than median sternal approach.Accurate and all-round TEE evaluation is very important to case selection of VSD.Individually procedure approach should be performed according to the size,position,and path and flow direction of VSD.

BACKGROUND:It has been demonstrated to be effective for the improvement of heart function after acute myocardial infarction with intravenous or intramyocardial administration of bone marrow mesenchymal stromal cels. However, little is known regarding the effect of the combination of intravenous and intramyocardial administration of mesenchymal stromal cels on the heart function of a chronic myocardial infarction model. OBJECTIVE:To study the effect of intravenous and intramyocardial administration of bone marrow mesenchymal stromal cels on the heart function of a rat chronic myocardial infarction model and the relevant mechanism. METHODS:Bone marrow mesenchymal stromal cels isolated from Lewis rats were expandedex vivo. BrdU-labeled bone marrow mesenchymal stromal cels (3×106) were administeredvia the femoral vein and the myocardial surface respectively into rat models of chronic myocardial infarction in cel transplantation group. The equal volume of PBS was injected into the same place in control group. Four weeks after injection, echocardiography was performed to evaluate the heart function, and then the heart tissues were harvested for immunohistochemistry examination. The total blood vessel density in the scar area was evaluated. RESULTS AND CONCLUSION:At 4 weeks after cel implantation, the left ventricular function was not improved in the two groups. The immunohistochemistry staining showed that (1) the mesenchymal stromal cels in the myocardium did not differentiate to myocardial cels; (2) there was no significant difference in the total blood vessel density in the scar area between the cel transplantation and control groups. Taken together, the combined intravenous and intramyocardial administration of bone marrow mesenchymal stromal cels cannot improve heart function in a rat chronic myocardial infarction model.

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OBJECTIVETo observe the effects of self-made spinal expander in treatment of compression fracture of osteoporotic vertebral body.

METHODSNinty-six patients were randomly divided into two groups, treatment group included 42 cases with 56 centrums, 14 males and 28 females, aged from 50 to 69 years, and control group included 54 cases with 68 centrums, 19 males and 35 females, aged from 51 to 75 years. All cases were examined by X-ray and CT. MRI was taken in 27 patients to make sure the diagnosis which was compression fracture of vertebral body due to osteoporosis. The degree of osteoporosis was judged by X-ray of L3 bone trabecula. Fifty-six centrums in treatment group were treated with self-made spinal expander and bone cement. Sixty-eight centrums in control group were treated with PVP. Compression rate and recovery rate of vertebral height, and leakage rate of bone cement were measured according to the Lee standard.

RESULTS(1) VAS between treatment group and control group had significant statistically difference (P<0.05). (2) In treatment group, compression rate of anterior and middle vertebal height were statistical difference before and after operation (P<0.05). In control group, the compression rate of pre-and post-operative vertebal height had no significant difference (P>0.05). (3) The recovery rate of kyphosis between treatment group (71.8%) and control group (37.8%) was significant statistically difference (P<0.05). (4) There was no cement leakage in the treatment group, however the leakage rate in control group was 47%. (5) The curative effect was assessed based on the standard of WHO. In treatment group, 36 cases was completely relieved, 4 cases was partially relieved and the relief rate was 95.24%. In control group, 43 cases was completely relieved, 3 cases was partially relieved and the relief rate was 84.19%. There was no statistically significant difference between two groups (P<0.05).

CONCLUSIONThe self-made spinal expander is a minimal invasive technique, which can substitute the imported balloon. This technique can alleviate pain rapidly and recover the height of vertebral body.

Adolescent ; Adult ; Female ; Fractures, Compression ; surgery ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; instrumentation ; Osteoporosis ; complications

Objective:To evaluate the role of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels in striatum in paclitaxel-induced neuropathic pain and the relationship with GABA B receptors in rats. Methods:Healthy clean-grade male Sprague-Dawley rats, aged 6-9 weeks, weighing 180-220 g, were used in this study.The neuropathic pain model was established by intraperitoneal injection of paclitaxel 2 mg/kg once every 2 days for 7 consecutive days in anesthetized rats, and then intrathecal catheterization was performed.Fifty rats in which intrathecal catheters were successfully implanted were divided into 5 groups ( n=10 each) using a random number table method: paclitaxel group (P group), paclitaxel plus normal saline group(N group), paclitaxel plus lentivirus empty vector group (BV group), paclitaxel plus HCN4 channel lentivirus group (H group), and paclitaxel plus HCN channel inhibitor ZD7288 group (I group). Ten rats of the same age were selected as the blank control group (C group). At 15 days after intraperitoneal injection of paclitaxel, normal saline 20 μl was intrathecally injected in group N, group BV received intrathecal injection of HCN4 channel lentivirus empty vector 1×10 8 TU/ml, 20 μl, group H received intrathecal injection of HCN4 channel lentivirus 1×10 8 TU/ml, 20 μl, and group I received intrathecal injection of ZD728830 μg, 20 μl.The mechanical paw withdrawal threshold (MWT) was measured at 1 day before paclitaxel injection and 14 and 21 days after injection.The cerebral striatum tissues were obtained at T 2, and the expression of HCN4 channel and GABA B receptors was determined by immunohistochemistry and Western blot. Results:Compared with group C, the MWT was significantly decreased, HCN4 channel expression was up-regulated, and GABA B receptor expression was down-regulated in group P ( P<0.05). Compared with group P, the MWT was significantly increased, HCN4 channel expression was down-regulated, and GABA B receptor expression was up-regulated in group H and group I ( P<0.05), and no significant change was found in the parameters mentioned above in group N and group BV ( P>0.05). Conclusion:Up-regulation of expression of HCN4 channels in striatum can induce down-regulation of GABA B receptor expression, which is involved in the pathophysiological mechanism of paclitaxel-induced neuropathic pain in rats.

Objective    To analyze the near-term clinical efficacy of two different surgical procedures (Sun's procedure and Debranching combined endovascular stent-graft procedure) to cure Stanford type A aortic dissection, and summarize the clinical experience to help better master the indications of the two surgical procedures. Methods     We retrospectively analyzed the clinical data of 46 patients with Stanford A aortic dissection in our hospital between September 2014 and September 2017. There were 39 males and 7 females at age of 20–74 (48.67±11.80) years. According to different surgical methods, the patients were divided into a Sun's procedure group (26 patients) and a debranching combined endovascular stent-graft procedure group (20 patients). The clinical effect of the two groups was compared. Results     The debranching combined endovascular stent-graft procedure group was significantly superior to the Sun's group in cardiopulmonary bypass (CPB) time, aortic cross clamp(ACC) time, intraoperative urine output, postoperative mechanical ventilation time, postoperative 24 h volumes of drain, CICU time, renal function recovery of postoperative 72 h and total hospital stay(P<0.05). The incidence of transient neurological damage after operation in the debranching combined endovascular stent-graft procedure group was significantly lower than that of the Sun's procedure group(P<0.05). The follow-up time ranged from 3 to 36 months. And the follow-up rate was 90.5%. One patient in the Sun's procedure group died of serious pulmonary infection postoperative 30 days. One patient in the debranching combined endovascular stent-graft group was found to have internal leakage in the early postoperative examination and   disappeared after 6 months. Sun's procedure group did not find endoleak. All patients during the follow-up time did not appear brain, coagulation disorders, stroke, paraplegia, upper limb ischemia and other complications. Conclusion     For Stanford type A aortic dissection, debranching combined surgery may have the risk of postoperative endoleak, but the overall effect is superior to Sun's operation. Therefore, debranching combined surgery should be preferred for the treatment of this type of dissection.

Objective    To analyze the effect of loop-in-loop technique and annuloplasty ring for the treatment of mitral valve prolapse (MVP) under total thoracoscopy. Methods    Between May 2012 and May 2017, 21 patients with MVP underwent mitral valve repair in our hospital. There were 12 males and 9 females with a mean age of 50.90±9.66 years and the mean weight of 64.81±11.56 kg. Loop-in-loop artificial chordae tendonae reconstruction and mitral annuloplasty were performed through the right atrial-atrial septal incision under total thoracoscopy. The water test and transesophageal echocardiography were performed during the operation to evaluate the effect of mitral annuloplasty. Data of echocardiography and chest radiography were collected postoperatively one week, before discharge and after discharge. Results    All the operations were successful without re-valvupoplasty or valve replacement, conversion to median thoracotomy, malignant arrhythmia, perioperative death or wound infection. Among them, 10 patients underwent tricuspid valvuloplasty, 1 patient underwent tricuspid valvuloplasty plus radiofrequency ablation simultaneously. The mean cardiopulmonary bypass time was 255.57±37.24 minutes, aortic occlusion time was 162.24±19.61 minutes, the number of loop was 2–5 (3.29±0.78), the size of ring was 28–34 (31.11±1.88) mm, ventilator assistance time was 19.43±14.68 hours, ICU time was 58.45±24.60 hours and postoperative hospital stay was 12.28±3.61 days. Transthoracic echocardiography was re-examined postoperatively. Mild-mitral regurgitation was found in 3 patients. Warfarin anticoagulant therapy was given orally for 6 months postoperatively. The patients were followed up regularly for 2–51 months at 1, 3, 6 and 12 months postoperatively. Left ventricular end-diastolic diameter (LVEDD) was 45.06±2.96 mm, left ventricular end-diastolic volume 108.11±17.09 mL, left atrial diameter (LAD) 35.56±6.93 mm and cardiothoracic ratio 0.53±0.13 at discharge which were significantly smaller than those at admission (P<0.05). Pulmonary artery pressure was 19.22±6.38 mm Hg which was significantly lower than that at admission (P<0.05), but left ventricular ejection fraction (62.33%±4.00%) had no significant change (P>0.05). The LAD and LVEDD were significantly smaller than those before operation, and the cardiac function improved to some extent during the follow-up. No new mitral valve prolapse, increased regurgitation, infective endocarditis, thromboembolism or anticoagulation-related complications were found during the follow-up. Conclusion    Loop-in-loop artificial chordae tendon implantation combined with mitral annuloplasty is a safe and effective method for MVP under total thoracoscopy with minimal trauma, satisfactory cosmetic effect, and good early- and medium-term results. It is worth of popularizing. However, the operation time needs to be further shortened, and its long-term clinical effect needs further follow-up and other researches to confirm.