0.05). Conclusions With intravenous injection of low-dose combination, droperidol and fentanyl can produce effective, painless and safe sedation for TEE examination.

Objective To explore the improving way to repair the lower one-third of leg soft tissue defect transferred the adjacent flap with non-main vessel pedicle. Methods Analyzing 42 cases.using 4 kinds flaps with nonmain vessel pedicle.If it is fine the skin around soft tissue defect of the lower one-third shank,choosing adjacent adversed sural neurotaneous vascular flap or sapheenous nerve vascular flap.If the skin damaged,chosing gastrocnemius flap.If the soft tissue defect was large,combined adversed sural neurotaneous vascular flap with gastrocnemius flap.Osteomyelitis and peroneus previs musculocutaneous flaps were choosed for small soft tissue defect. Results All case observed 6 to 12 months,37 cases were survived completely,5 cases distal part necrsis partly,among them,2 cases transferred flap repaired;1 case musculocutaneous flap transferred, 2 cases after granulation tissue grown,skin grafted. Conclusion The flap transferred adjacent non-main vessel pedicle is the best way to repaire soft tissue defect of one-third lower leg.Different flap can fit with kinds of soft tissue defect.

BACKGROUND:Long-term patency rate of smal-caliber artificial blood vessels is stil the most important issue to be solved.
OBJECTIVE:To review the materials and fabrication technologies of smal-caliber artificial blood vessels as wel as endothelialization of smal-caliber artificial blood vessels.
METHODS:A computer-based search of PubMed (2000-2013) and Wanfang database (2003-2013) was done for relevant articles using the key words of“smal-caliber, vascular graft, electrospun, layer-by-layer assembly, endothelialization”in English and Chinese, respectively. A total of 125 articles were retrieved, and final y, 41 were included for further analysis.
RESULTS AND CONCLUSION:At present, smal-caliber vascular graft materials include natural biological materials, biodegradable polymers, composite materials and xenogeneic biomaterials. Preparation technologies of smal-caliber artificial blood vessels mainly include electrospinning, self-assembly, rapid prototyping, and gel spinning. Numerous methods can elicit endothelialization of smal-caliber artificial blood vessels, but each method has its flaws and cannot ensure long-term patency radical y. With the development and diversification of preparation technologies and in-depth study of endothelialization of vascular prostheses, the long-term patency of smal-caliber artificial blood vessels wil gradual y be resolved.

In strengthening the management and innovation of the practical teaching of c1inical medicine,we have taken the right turning and got a satisfactory result:the quality of the clinical teaching work increasing unceasingly and the hospital developing comprehensively.Strengthening the clinical teaching proves to be one of the effective measures to guarantee the quality of the medical students and promote hospital construction and development.

Objective:The present study aimed to conduct a clinical analysis of nosocomial infections in hospitalized cancer pa-tients and propose effective precautionary measures. Methods:We retrospectively analyzed 56,430 cases of discharges from the Cancer Institute and Hospital of Tianjin Medical University between January and December 2012. Results:Among 825 cases, the rate of noso-comial infections was 1.46%;46.42%of the patients aged>60 years. The highest infection rate was observed in the Medical Depart-ment of Stomach Cancer. The highest composing rate was recorded in the Department of Hepatobiliary Cancer. The major pathogenic bacteria were Gram-negative bacilli;fungal infections were relatively rare. The most vulnerable body parts were the abdomen and diges-tive tract, which were mainly infected by pathogenic Escherichia coli. Conclusion:Healthcare workers should consider the importance of influencing factors and take precautionary measures to reduce the rate of nosocomial infections in cancer patients.

Objective To observe vasculogenic mimicry formation difference in human hepatocellular carcinoma cell lines MHCC97-H/L with different metastatic potentials under three-dimensional culture condition,and to study extracellular matrix and adhesion molecules-related mechanism of vasculogenic mimicry.Methods Three-dimensional cell culture system of MHCC97-H/L was established to observe tubelike structures by inverted microscope.Human umbilical vein endothelial cell(HUVEC),human hepatocellular carcinoma cell line Hep3B with non-metastatic potentials and normal human hepatic cell line HL-7702 were taken as control.Gene expression profiles of MHCC97-H and MHCC97-L were detected by Oligo extracellular matrix and adhesion molecules microarray analysis.Two differentially expressed genes were verified with semi-quantitative reverse transcriptionpolymerase chain reaction(RT-PCR)and Western blot.All data were analyzed using two sample t test.Results After a 24-hour three-dimensional culture,the length of tubelike structures was(474 ± 16)mm/cm2 in MHCC97-H,which were significantly longer than(320 ±41)mm/cm2 in MHCC97-L(t =6.119,P ＜0.05).Hep3B and HL-7702 could not form tubelike structures.Compared with MHCC97-L,the expression of 7 genes were up-regulated and the expression of 3 genes were down-regulated among a total of 113 angiogenesis genes in MHCC97-H.Two of the genes with differential expressions including tenascin C and extracellular matrix protein 1 were further validated by RT-PCR and Western blot.Conclusion MHCC97-H has stronger ability to form vasculogenic mimicry than MHCC97-L,and this perhaps correlates with the differential expression of certain extracellular matrix and adhesion molecules-related genes in MHCC97-H.

ObjectiveTo observe the effect of different extracts ofTangwang Mingmu Granule on hypoxia induced gene expressions in vascular endothelial cells.Methods COCl2 intervention cells were used to copy hypoxia models. Human umbilical vein endothelial cells EA. Hy926 were divided into blank group, hypoxia model group,Tangwang Mingmu Granule group, extract 1 (glycosides and flavonoids) group, extract 2 (orgain acids and polysaccharides) group and extract 3 (alkaloids) group. The changes in gene expressions of VEGF, VEGFR-1, VEGFR-2, ICAM-1 and IL-1α mRNA were detected by semi-quantitative RT-PCR.ResultsThe gene expression levels of VEGF, VEGFR-1, VEGFR-2, ICAM-1 and IL-1α were significantly up-regulated under the hypoxic condition (P<0.05), and the ratio of VEGFR-1/VEGFR-2 was significantly reduced. However,Tangwang Mingmu Granule significantly reversed the expressions of these genes.Conclusion The function intensity of gene expressions weakens in the following sequence:glycosides and flavonoids>alkaloids>organic acids and polysaccharides inTangwang Mingmu Granule.

Objective To investigate the feasibility to establish experimental model of autoimmune myocarditis and to study the value of echocardiographic assessment of left ventricular structure and function.Methods Seventy-two male 6 weeks old Lewis rats were randomly divided into 3 groups:normal control group,negative control group and positive group.Positive group were immunized with porcine cardiac myosin at days 0,7,30.Results ①The positive group showed weight loss,increased heart weight and myocardial necrosis with inflammatory infiltration.②The development of experimental autoimmune myocarditis included acute,subacute and chronic stages.The left ventricular diameter,ventricular wall thickness,left ventricular fractional shortening and ejection fraction of positive group differed significantly from those of other two groups.Conclusions Lewis rats immunized with porcine cardiac myosin may be a desirable experimental model of experimental autoimmune myocarditis,echocardiography can evaluate changes of cardiac structure and function accurately.

Objective To evaluate the application of echocardiography in guiding percutaneous balloon pulmonary valvuloplasty in children and to summarize the key echocardiographic planes used in the procedure Methods From February 2013 to September 201 5 38 isolated congenital pulmonary valve stenosis patients were recruited Case inclusion criteria age ≥3 years old purely congenital pulmonary valve stenosis and pulmonary transvalvular pressure gradient ≥40 mmHg Echocardiography was used to assess the severity of pulmonary valve disease and to measure pulmonary transvalvular pressure gradient before procedure Intraoperative transthoracic or transesophageal echocardiography was used to monitor the whole process of percutaneous balloon pulmonary valvuloplasty and to evaluate immediate postoperative efficacy of the procedure All patients were followed up by echocardiography after a month post-discharge Results Thrity eight cases were successfully treated by echocardiography-guided percutaneous balloon pulmonary valvuloplasty The average age of children was 7 1 ±2 5 years mean body weight was 25 3 ±7 1 kg Before the procedure pulmonary transvalvular pressure gradient was 65 9 ± 8 9 mmHg pulmonary annular diameter was 14 6±1 1 mm Immediate postoperative pulmonary transvalvular pressure gradient was 1 5 5 ± 3 4 mmHg All children survived and had no significant complications After a month pulmonary transvalvular pressure was 16 1 ± 3 3 mmHg Conclusions Echocardiography plays an important role in percutaneous balloon pulmonary valvuloplasty for children with congenital pulmonary valve stenosis As a non-x ray guided way it has advantages in preoperative screening of patients intraoperative real-time monitoring and postoperative assessment of efficacy The key sections of echocardiography for intraoperative monitoring are four-chamber and aortic short axis view.

Objective:To study the pharmacokinetics of propranolol in Wistar rats after acute exposure to high altitude.
Methods:Fourteen male Wistar rats (200±20) g were selected. After administration of propranolol tablets (0.05 g/kg, i.g.), blood samples (3 mL) were collected at 0, 20, 40 min,1, 1.5, 2, 4, 6, 8, 12 and 24 h, respectively. The pharmacokinetic parameters were determined by LC-MS/MS and DAS 2.0 software.
Results:The main pharmacokinetic area under concentration-time curve (AUC), mean retention time (MRT), half-life (t1/2) and peak plasma concentration (Cmax) of propranolol were increased by 442.61%, 47.45%, 73.13%and 352.97%, respectively, whereas Tmax and clearance (CL) were decreased by 80.87%and 68.94%, respectively.
Conclusion:This study displays significant changes in the pharmacokinetics of propranolol under high altitude, which may provide evidence for clinical rational application of propranolol at high altitude.