Objective To report experience of endovascular aneurysm repair (EVAR) with Endurant stent-graft for abdominal aortic aneyrysm. Methods Between May,2010 and May,2011,19 patients underwent EVAR with Endurant stent-graft at Department of Vascular Surgery,Peking Union Medical College Hospital. Clinical and morphological characteristics, operative result, peri-operative complications and follow-up data were reported. Results Procedures were successful in all these 19 cases,among those 9 were with complicated anatomical alterations.There were no type Ⅰ,Ⅲ and Ⅳ endoleak found immediately after procedure,while 4 cases were found with type Ⅱ endoleak. Major adverse event during the 30-days after operation included:consumption coagulopathy,myocardial infarction combined with heart failure,wound infection or hematoma.All cases were followed-up from 1 to 12 months. No death occurred.Eight cases had at least one CT angiography.Five cases showed aneurysm shrink,the remaining 3 cases showed aneurysm diameter did not change.One case suffered from occlusion of unilateral iliac limb artery obliteration,and was treated by fem-fem graft bypass.One case had secondary type Ⅰ B endoleak,without increase of aneurysm diameter. Conclusions EVAR with Endurant stent-graft is safe and effective.Some complicated anatomic cases could be treated successfully with Endurant stent-graft.

Objective To study the clinical manifestations,diagnosis and surgical treatment of tubular adenoma in the extrahepatic bile duct.Methods The clinical data of 3 patients with tubular adenoma in the extrahepatic bile duct who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from July 2010 to February 2012 were retrospectively analyzed.Results The tumors were located at the middle and lower part of the common bile duct.All the 3 patients received resection of the common bile duct and Roux-en-Y cholangioenterostomy,and recovered well.The results of pathological examination showed that all the patients were with tubular adenoma,and 2 patients had moderate atypical hyperplasia.Conclusions Tubular adenoma in the extrahepatic bile duct could be diagnosed by pathological examination.Radical resection and rerouting of the bile duct can get a better outcome.

Objective To explore the initial clinical and imaging characteristics of basal ganglia germinoma in children.Methods Four patients with basal ganglia germinoma were reported.Their clinical features,laboratory findings,radiological manifestations,treatment and outcome were analyzed.They recieved radiation therapy and chemotherapy after diagnosis.All patients were clinically diagnosed,according to the results of low-dose cranial irradiation.The outcomes were followed up for 2 years.Results All patients were male and school-aged(9-13 years) children.The course of the disease ranged from 5 to 13 months.All patients were presented with slowly progressive hemiparesis,and 2 cases of them were presented with cognitive decline and psychosis.Seizure occurred in 2 patients.The serum ?-human chorionic gonadotropin(?-hcG) level was significantly increased in 2 patients(30.16 IU/L and 77.85 IU/L,respectively),and mildly elevated in 1 patient(4.29 IU/L),while serum ?-hcG level in another case was within normal control range.MRI demonstrated mildly high intensity in the left or right basal ganglia on T1-weighted and T2-weighted images without remarkable occupying lesion.Ipsilateral hemiatrophy of the hemisphere and midbrain was also noted.Inhomogeneous Gd-DTPA enhancement was observed.All patients had been treated with radiation therapy and chemotherapy.During 2 years follow up,significant improvement was observed in all patients after therapy,imaging lesions disappeared and the elevated ?-hcG level of those elevated before therapy returned to normal.Conclusions Early diagnosis and treatment for basal ganglia germinoma are critically important to improve the prognosis.In young male patients with progressive hamiparesis,basal ganglia germinoma should be considered for differentiation,if abnormal high intensity signals in basal ganglia on T1-weighted and T2-weighted image with ipsilateral hemiatrophy of the hemisphere are demonstrated on MRI,even without occupying effect.

Objective To explore the effect of ParidissaponinⅠ (PSⅠ) on the proliferation of coronary artery endothelial cells (CAECs).Methods CAECs were cultured with PSⅠ.CAEC growth rate was calculated by using blood cell counting plate.Cell viability was measured by MTT.The expressions of cadherin and caspase3 mRNA were detected by RT-PCR.Results PSⅠ slowed down growth rate of CAECs,reduced cell viability of CAECs,decreased the expression of cadherin mRNA and increased the expression of caspase3 mRNA in CAECs.Conclusion PSⅠ inhibits the proliferation of CAECs and induces CAECs apoptosis.

Humans ; Infant ; Neuroaxonal Dystrophies ; diagnosis

OBJECTIVE:To study the international experiences on essential medicine policy and to provide useful reference for the establishing and improving of essential medicine policy in China.METHODS:The practice and experiences on essential medicine policy of countries at different level of national income were analyzed.RESULTS & CONCLUSION:Experiences from Austria,India,South Africa and Zimbabwe etc suggest that a good strategy to improve the availability of essential medici-nes should give priority consideration to the pharmaceutical system and develop essential medicine policy on the basis of a holistic framework including essential formulary as well as rational pricing and reimbursement systems.

Obiective:To elucidate the phenotype and the genotype-phenotype correlations in Chinese patients with X-linked adrenoleukodystrophy(X-ALD).Methods:Clinical features of 40 Chinese patients with X-ALD were studied and mutation spectrums were investigated by polymerase chain reaction (PCR) and sequencing. Results:Among these patients, four were siblings from two unrelated families, the others were unrelated. There were 31 cases with childhood cerebral (CCALD), 8 cases with adolescent cerebral (ACALD) and 1 case with adrenomyeloneuropathy (AMN). Visual impairment, which presented in 12 cases (30%), was the most common initial symptom. Nine (69%) of 13 cases who had hydrocortisone and ACTH measured showed adrenal insufficiency. By follow-up date, 19 cases (47.5%) were dead. The interval from onset to death varied from 1 to 6 years and the average were 3.3 years. The mean age at death was 10.5 years. Eleven cases (27.5%) were in vegetable state. The mean interval from onset to apparently vegetable state was 2.8 years (range from 1 to 6 years). Four cases had progressive neurological disability. Four cases were lost follow-up. One case with CCALD and one case with ACALD progressed slowly. The courses of the disease of these two patients were 5 years and 15 years respectively. Thirty five mutations were identified in 40 cases. Most were located within exon 1-3 (40%, 16/40) and exon 6-8 (42%, 17/40). There is a distinct clustering of missense mutations in exon 6 (17%, 7/40). Five types of mutations were associated with CCALD, three with ACALD and a missense mutation was identified in the patients with AMN. The two patients with long disease courses had a missence mutation c.1559 T>A and a nonsense mutation c.1785 G>A respectively. The siblings with similar manifestations and onset age were observed in two families, whose mutations were c.887 A>G and c.1028 G>T. Conclusion:The phenotypes, disease severity and rate of neurodegeneration could not be predicted by the nature of mutations.

Objective To explore the clinical characteristics of cardiac involvement in children with mitochondriopathies.Methods The clinical data of 23 children with mitochondriopathies were reviewed.The changes of electrocardiography,echocardiography and heart enzymes were analyzed.Results In 15 cases of mitochondrial encephalomyopathy,lactic acidosis,and stroke-like episode(MELAS syndrome),electrocardiography was performed on 9 cases,6 of them showed abnormal electrocardiographic findings,including right bundle branch block,ST-T change,Wolff-Parkinson-White syndrome,et al.On echocardiographic examination in 9 MELAS syndrome ca-ses,only 1 case showed hypertrophy cardiomyopathy.Six cases had increased plasma creatine kinaseMB(CK-MB) mass and only one of 12 MELAS syndrome cases had increased cardiac troponin I(cTnI) level.In 8 cases of subacute necrotizing encephalomyopathy(Leigh syndrome),electrocardiography was performed on 5 cases,4 of them showed abnormal electrocardiographic findings,including sinus tachycardia,ST-T change and low voltage.Two cases showed normal electrocardiography.Three out of 6 cases with Leigh syndrome showed increased plasma CK-MB mass.The molecular genetic examinations were performed in 13 cases of MELAS syndrome and 6 cases of Leigh syndrome.The mitochondrial DNA nt 3243 A→G mutation was found in white blood cells of 9 MELAS syndrome cases,the mutation rate being 37%-60%.The mitochondrial DNA nt 8993 T→C mutation was found in white blood cells of 2 Leigh syndrome cases.Conclusion In children with mitochondriopathies,myocardiac involvement is comparatively common,and even cardiomyopathy can occur.

Objective To evaluate the result of revascularization for lower limb artery ischemia in elder patients. Method During Jan 2006 to Nov 2008, 262 elder patients (60 years old and up), underwent artery revascularization for lower limb arterial ischemia. Mortality, morbidity, primary patency, secondary patency and limb salvage were analyzed. Result There were a total of 323 ischemia limbs in those 262 elder patients undergoing revascalarization, among those 102 limbs underwent artery bypass, 98 limbs underwent endoluminal angioplasty with or without stenting, 67 limbs underwent embolectomy or endarterectomy, 56 limbs underwent open surgery combined with endoluminal treatment due to multiple segment lesions. Operation success rate was 94.7%. Two patients died within 30 days. Perioperative morbidity developed in 15 cases. 245 patients (93.5%) were followed-up from 1 month to 35 months. Mortality was 6.1% (15 cases), primary patency was 80.5%, secondary patency was 92.7% and limb salvage rate was 95.2%. Risk factors analysis showed that history of cardiac disease and elder ages were associated with higher mortality. Diabetes mellitus, critical ischemia and multiple segment lesions were associated with poor long term patency and limb salvage. Conclusion Lower limb ischemia is severe disease related to elder patients' death and amputation. Careful patient selection, detailed pre-operation work-up, meticulous operative technique play crucial roles for a successful arterial reconstruction.

OBJECTIVETo observe the effects of Mongolian pharmaceutical Betel shisanwei ingredients pill on AC-cAMP-PKA signal transduction pathways in hippocampus and prefrontal cortex of depressive rats.

METHODSixty male Wistar rats were randomly divided into six groups according to the sugar consumption test (10 rats in each group), normal control group,model group,fluoxetine group (3.3 mg x kg(-1)) and low dose, medium dose and high dose group (0.25, 0.5, 1 g x kg(-1)) of Betel shisanwei ingredients pill. Except the normal control,the other groups were treated with the chronic unpredictable mild stress stimulation combined with lonely raising for 28 days. 10 mL x kg(-1) of drugs were given to each rat once daily,continuously for 28 days. The AC activity of the hippocampus and prefrontal cortex were determined by radiation immunity analysis (RIA), while cAMP and PKA quantity were determinated by Enzyme-linked immunosorbent (ELISA).

RESULTThe AC activity, cAMP and PKA quantity of hippocampus and prefrontal of mouse model of Chronic stress depression decreased significantly than those of control group (P < 0.05 or P < 0.01). However, the AC activity, cAMP and PKA quantity of rat hippocampus and prefrontal cortex in the fluoxetine group and the Mongolian pharmaceutical Betel shisanwei ingredients pill group indecreased significantly than those of model group (P < 0.01 or P < 0.05). Especially for the high dose group of Mongolian pharmaceutical Betel shisanwei ingredients pill.

CONCLUSIONThe AC-cAMP-PKA signal transduction pathways in hippocampus and prefrontal cortex of depression model of rats is down-regulated, whereas Mongolian pharmaceutical Betel shisanwei ingredients pill could up-regulated it to resist depression.

Adenylyl Cyclases ; genetics ; metabolism ; Animals ; Cyclic AMP ; metabolism ; Cyclic AMP-Dependent Protein Kinases ; genetics ; metabolism ; Depression ; drug therapy ; genetics ; metabolism ; Drugs, Chinese Herbal ; administration & dosage ; Hippocampus ; drug effects ; metabolism ; Humans ; Male ; Mice ; Prefrontal Cortex ; drug effects ; metabolism ; Rats ; Rats, Wistar ; Signal Transduction ; drug effects