ObjectiveTo evaluate the effect and safety of different thrombolytic therapies for acute cerebral infarction due to occlusion of middle cerebral artery(MCA).MethodsOne hundred and thirty-two cases of acute cerebral infarction in territory of MCA were randomly divided into 3 groups,all of which were treated with alteplase.Group A (48 cases) was treated by intra-venous therapy with alteplase,group B (43 cases) was treated by infusing alteplase at the site of the internal carotid artery,and group C(41 cases) was treated by infusing alteplase into the thrombus.The improvement of neurological function,complications and mortality rate were recorded and statistically compared,with analysis of variance for counting data of normal distribution,x2 test for quantitative data,and the mean difference was significant at the 0.05level.ResultsThe effective rates of group A,B and C at 2 h,24 h,2 w were 18.8％ (9/48),39.6％ ( 19/48),45.8％ (22/48) ;39.5％ (17/43),53.5％ (23/43),58.1％ (25/43) ;78.0％ (32/41),85.4％ (35/41 ),87.8％ (36/41)respectively.The effective rate of group C was obviously better than group A( x2 =12.809,9.979,9.289,P ＜ 0.01 ) and B (x2 =31.295,19.425,17.161,P ＜ 0.01 ) with statistical significance.The effective rate of group B was better than group A at 2 h after thrombolytic therapy with statistical significance (x2 =4.801,P ＜ 0.05 ).The effective rate of group A and B did not have significant difference at 24 h,2 w after therapy ( x2 =1.765,1.375,P ＞ 0.05 ).The hemorrhage rates of group A,B and C were 14.6％ (7/48),14.0％ (6/43),7.3％ (3/41 ),the mortality rates of group A,B and C were 6.2％ (3/48),4.6％ (2/43),2.4％ (1/41),and there was no significant difference among the 3 groups ( x2 =1.328,0.786,P ＞ 0.05 ).ConclusionIt is suggested that the thrombus-imbeded thrombolytic therapy is a better way in treating acute cerebral infraction due to occlusion of MCA for its rapid and better therapeutic effect.

Objective To investigate the early diagnostic value of plasma D-dimer level in acute aortic dissection (AAD) . Method A total of 80 patients with chest pain were enrolled from January 2006 to March 2009, and 40 patients of them were confirmed to be AAD with computerized tomographic angiography (CTA), and these patients were matched with 40 controls presenting suspected dissection, which were ruled out later. The D-dimer test was performed in all patients within 12 hours after onset of chest pain,and plasma D-dimer concentrations were compared between two groups. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of D-dimer used for diagnosing AAD were analyzed. The receiver operating characteristic (ROC) curve was also established. The statistical analysis of data was carried out by using Mann-Whitney test with SPSS 11.5 software. Results The plasma D-dimer oncentrations in AAD were significantly higher than those in controls [(5.48±7.95) vs. (0.64±0.75), P <0.0l]. Receiver operating characteristic curve analysis showed that D-dimer ( > 0.5 μg/mL) was predictive in the diagnosis of AAD, and the area under ROC curve was 0.848 ± 0.042, (95% CI: 0.766-0.930) with 87.5% sensitivity, 62.5% specificity,70% PPV and 83.3% NPV. Conclu-sions D-dimer may be a valuable biomarker in early diagnosis of AAD.

Aim To study the effects of Free Anthra-quinone from Rhubarb (FAR)on myocardial CTGF and collagen expression and interstitial fibrosis in dia-betic rats.Methods The male SD rats were randomly divided into normal group (CON),diabetic cardiomy-opathy group (DCM) and FAR treatment group (FAR).Streptozocin was intraperitoneally injected in-to the animals in the latter 2 groups to induce diabetic rat model.The model was expected to be stable for 2 weeks before the treatment.At the end of the 8th week in treatment,fasting plasma glucose and heart mass in-dex were measured.Masson staining was used to ob-serve the myocardial fibrosis.RT-PCR was used to de-tect the mRNA levels of CTGF,procollagen type Ⅰand collagen type Ⅲ.Immunohistochemical method was used to detect the content of CTGF.ELISA was used to detect the depositions of collagen type I and collagen type Ⅲ. Results Compared with CON group,fasting plasma glucose,heart mass index,the degree of myocardial fibrosis,and the expressions of CTGF,collagen type I and collagen type Ⅲ in left ven-tricular myocardial tissue of DCM group were signifi-cantly increased. However, compared with DCM group,fasting plasma glucose,heart mass index,the degree of myocardial fibrosis,and the expressions of CTGF,collagen type I and collagen type Ⅲ in left ven-tricular myocardial tissue of FAR-treated rats were sig-nificantly decreased.Conclusion FAR retards the process of myocardial fibrosis in diabetic rats by down-regulating the expression of CTGF,reducing the syn-thesis and depositions of collagen type I and collagen type Ⅲ.

BACKGROUNDTraditionally, displaced greater tuberosity fractures are treated with open reduction and internal fixation. Arthroscopic treatment and outcome of greater tuberosity fractures is far from comprehensive. The objective of the current study was to assess the surgical procedure and outcome of an arthroscopic method in the treatment of isolated greater tuberosity fractures.

METHODSFrom January 2006 to December 2009, 23 patients with isolated greater tuberosity fractures were treated with an arthroscopic procedure using three cannulated screws combined with washers. During follow-up, radiographs and the constant shoulder score (CSS) were used to evaluate the outcome.

RESULTSThree cannulated screws with washers were used to fix the fractured fragment of the greater tuberosity under an arthroscope. All incisions healed at primary intention without infection. The mean duration of follow-up was 20 months (range 18 - 36 months). Fracture fixation was excellent, and fractures healed 2 - 6 months (mean 3.8 months) after surgery. At final follow-up, the CSS was 92 (range 86 - 100).

CONCLUSIONSThe described arthroscopic procedure provides anatomical reduction and firm fixation for isolated greater tuberosity fractures. It is a successful and minimally invasive procedure with satisfying therapeutic effects as well as excellent functional recovery.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Treatment Outcome

BACKGROUNDBronchial carcinoids are rare malignant neuroendocrine neoplasms. Some issues regarding surgical treatment of bronchial carcinoids remain controversial, including the role of bronchoplastic surgery and necessity of systematic lymphadenectomy.

METHODSThis retrospective study involved 131 consecutive patients surgically treated for carcinoid tumors at Shanghai Chest Hospital between March 1990 and August 2010.

RESULTSEighty-nine (67.9%) of the patients were male, and the mean age was 46 years, ranging from 17 to 81 years. Preoperative fiberoptic bronchoscopy was performed in all patients. Endoscopic biopsy was performed in 100 patients with central tumors, and 70 (70%) patients were diagnosed as bronchial carcinoid. The resections performed consisted of 31 pneumonectomie, 32 lobectomies, 26 bilobectomies, 34 sleeve lobectomies, six bronchoplastic procedures without lung resection, and two segmentectomies. During a median of 87 months follow-up, there were nine recurrences including three local recurrences and 6 distant recurrences. No bronchial recurrences were observed. The 3-, 5- and 10-year overall survival rates of pneumonectom and bronchoplastic surgery (including sleeve lobectomy and bronchoplastic procedure without lung resection) were 93.2%, 81.0% and 69.4%, 97.5%, 91.9% and 70.0%, respectively. Multivariate Cox regression indicated that histology and nodal status were significant independent prognostic factors.

CONCLUSIONSBronchoplastic surgery should be considered whenever possible for central carcinoids. Systematic lymphadenectomy is recommended for bronchial carcinoid patients. Histology and nodal status were significant independent prognostic factors of overall survival of patients with bronchial carcinoid.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoid Tumor ; mortality ; surgery ; Female ; Humans ; Lung Neoplasms ; mortality ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Treatment Outcome

In this paper, we present a virtual endoscopy (VE) for diagnosis of heart diseases, which is proved efficient and affordable, easy to popularize for viewing the interior of the heart. The dual source CT (DSCT) data were used as primary data in our system. The 3D structure of virtual heart was reconstructed with 3D texture mapping technology based on graphics processing unit (GPU), and could be displayed dynamically in real time. When we displayed it in real time, we could not only observe the inside of the chambers of heart but also examine from the new angle of view by the 3D data which were already clipped according to doctor's desire. In the pattern of observation, we used both mutual interactive mode and auto mode. In the auto mode, we used Dijkstra Algorithm which treated the 3D Euler distance as weighting factor to find out the view path quickly, and, used view path to calculate the four chamber plane.
Algorithms ; Endoscopy ; methods ; Heart ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Tomography, Spiral Computed ; methods ; User-Computer Interface

AIM:To investigate the RELMα/FIZZ1 signaling pathway on the regulation of the Ca 2+/CaM sig-naling pathway in the mouse aortic smooth muscle cells MOVAS and on the formation of blood vessels in the mouse aortic endothelial cells(MAEC).METHODS:The MAEC cultured in vitro were divided into pGSadeno-HK group,pGSadeno-RELMα/FIZZ1 group,pGSadeno-shRNA control group and pGSadeno-shRNA RELMα/FIZZ1 group.MTT assay was used to detect the viability of the MAEC.The formation of stroma tubes was observed for determining angiogenesis.The MOVAS cells cultured in vitro were also divided into pGSadeno-HK group,pGSadeno-RELMα/FIZZ1 group,pGSadeno-shRNA con-trol group and pGSadeno-shRNA RELMα/FIZZ1 group.The viability of MOVAS cells was measured by MTT assay.Fluo-3 AM fluorescence probe was used to detect intracellular Ca 2+concentration.The expression of calmodulin(CaM)and my-osin light chain kinase(MLCK)at mRNA and protein levels was determined by real-time PCR and Western blot.RE-SULTS:Over-expression of RELMα/FIZZ1 significantly promoted the viability of the MAEC.The number of lumen forma-tion was increased significantly(P<0.05).Knockdown of the RELM α/FIZZ1 expression inhibited the viability and lumen formation of MAEC(P <0.05).Over-expression of RELMα/FIZZ1 significantly promoted the viability of the MOVAS cells,enhanced the mean fluorescence intensity of intracellular Ca 2+,and the expression of CaM and MLCK at mRNA and protein levels was significantly increased.Knockdown of the RELMα/FIZZ1 expression significantly inhibited the viability of the MOVAS cells,the mean fluorescence intensity of Ca 2+was decreased, the expression of CaM and MLCK at mRNA and protein levels was decreased significantly(P<0.05).CONCLUSION:RELMα/FIZZ1 signaling pathway is involved in the angiogenesis,and the mechanism may be related to the changes of intracellular Ca 2+concentration and then to regu-late the intracellular CaM and MLCK expression.

BACKGROUND: The application of coronary stents, especially drug-eluting stents (DESs), has made percutaneous coronary intervention (PCI) one of important therapeutic methods for CHD. DES has reduced the in-stent restenosis to 5％–9％ and signifi cantly improved the long-term prognosis of patients with CHD. The study aimed to investigate the long-term efficacy and safety of domestic drug-eluting stents (DESs) in patients with acute coronary syndrome (ACS). METHODS: All patients with ACS who had undergone successful percutaneous coronary intervention (PCI) in the First Affiliated Hospital of Zhengzhou University from July 2009 to December 2010 were included in this study. Patients were excluded from the study if they were implanted with bare metal stents or different stents (domestic and imported DESs) simultaneously. The included patients were divided into two groups according to different stents implanted: domestic DESs and imported DESs. RESULTS: In the 1683 patients of this study, 1558 (92.6％) patients were folowed up successfuly for an average of (29.1±5.9) months. 130 (8.3％) patients had major adverse cardiovascular events (MACEs), including cardiac death in 32 (2.1％) patients, recurrent myocardial infarction in 16 (1％), and revascularization in 94 (6％). The rates of cardiac death, recurrent myocardial infarction, revascularization, in-stent restenosis, stent thrombosis and other MACEs were not significantly different between the two groups (allP>0.05). Multivarite logistic regression revealed that diabetes mellitus (OR=1.75, 95％CI: 1.09–2.82,P=0.021), vascular numbers of PCI (OR=2.16, 95％CI: 1.22–3.83, P=0.09) and PCI with left main lesion (OR=9.47, 95％CI: 2.96–30.26,P=0.01) were independent prognostic factors of MACEs. The Kaplan-Meier method revealed that there was no significant difference in cumulative survival rates and survival rates free from clinical events between the two groups (allP>0.05). CONCLUSIONS: The incidences of clinical events and cumulative survival rates are not statistically different between domestic DESs and imported DESs. Domestic DES is effective and safe in the treatment of patients with ACS.

OBJECTIVE: To accumulate experience for dated forensic matter analysis, for example, Mummy. METHODS: DNA are extracted by methods of phenol-chloroform and are purified by Wizard DNA clean-up system. The STRs locus are ampolification with Promega Powerplus 16 system. The mtDNA hypervariable region 1 (HV1) is amplificated by '3 pair primers'. The products were sequenced with 377 DNA sequencer. RESULTS: The STRs locus very distinctness and mtDNA sequence is correct. CONCLUSION It is a valuable method for special forensic matters.
Base Sequence ; DNA/genetics* ; DNA, Mitochondrial/genetics* ; Forensic Medicine ; Humans ; Microsatellite Repeats/genetics* ; Molecular Sequence Data ; Mummies ; Sequence Analysis, DNA/methods*

Objective To study the microscopic anatomy of the petroclival region through simulated subtemporal transtentorial and transpetrosal presigmoid approaches, and discuss their respective scope for clinical application and provide reference to petroclival region surgical approaches. Methods Ten wet adult head specimens (20 sides) were studied by subtemporal transtentorial and transpetrosal presigmoid approach under microscope, respectively; the features of vessels and nerves of the petroclival area, microanatomic relations of vessels and nerves with their surrounding structures were researched; the exposure scope of these two operative approaches to petroclival region was described. Results The trochlear nerve entered the edge of tentorium in post-lateral posterior clinoid process with a mean distance of (15.72±3.81) mm, and it sneaked (6.82±1.81) mm in the tentorium into the external wall of the cavernous sinus. When the tentorium was cut off, it could expose the posterior clinoid process and posterior communicating artery at upper bound, and petrous ridge at lower bound. The distance from petrous sigmoid sinus junction to the posterior semicircular canal was about (10.48 ±0.42) mm, Trautman's triangle could be exposed about (243.5±26.1) mm2. The rear of the cavernous sinus, Meckel's cavity and saddle back at upper bound, the contralateral slopes at the inside, and the bridge of groove and ventral medulla oblongata at lower bound could be reached via transpetrosal presigmoid approach. Conclusions Subtemporal transtentorial approach mainly applys to the upper, middle parts of slopes and petrous apex lesions;the temporal lobe needs to be lifted in the operation, which may damage Labbe vein. Transpetrosal presigmoid approach can be applied to superior, middle and inferior slope and petrous apex lesions, it has advantage of light pulling brain tissues and wide exposure than subtemporal transtentorial approach; however, intraoperative trauma and long operation time may cause hearing impairment and cerebrospinal fluid leakage.