OBJECTIVE: To probe into the status quo and future tendency of utilization of cardiovascular drugs in hospital of high altitude area. METHODS: Consumption sum and DDDs of cardiovascular drugs used in our hospital were analyzed statistically during 2006～2008. RESULTS: Consumption sum of cardiovascular drugs was increased year by year as well as its percentages in the total consumption sum. Top 10 cardiovascular drugs in terms of consumption sum mainly included antianginal drugs, antihypertensive drugs, blood fat harmimegathy drugs and antithrombotics drugs. Consumption sum of antianginal drugs which had occupied 44% in that of cardiovascular drugs took the dominate place in three years. Consumption sum of antihypertensive drugs was increased fast as well as its percentage in cardiovascular drugs about more than 20%. Consumption sum of antithrombotics drugs had occupied about 22%. CONCLUSION: Requirement of cardiovascular drugs was increased year by year. Cardiovascular drugs from foreign countries and joint stock take main place. It is necessary to explore domestic substitute drugs to decrease the cost of cardiovascular drugs.

Objective To evaluate the significance of immediate early 1 (IE) mRNA detection by nucleic acid sequence-based amplification (NASBA) in the diagnosis of human cytomegalovirus (HCMV) infection after renal transplantation.Methods The expression of IE-mRNA and pp67-(mRNA) was detected by NASBA in 55 patients after renal transplantation, and pp65 antigenemia (assays) were done for all cases.Results Twenty cases were positive for IE-mRNA. Thirteen cases were suffered from CMV disease with symptoms. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of IE-mRNA by NASBA were 92.3 %, 80.9 %, 60.0 % and 97.1 %, respectively. Time to first IE-mRNA positive detection after transplantation was shortest, compared with pp67 and antigenemia (P

Objective To evaluate hemodynamic status,pathological,imaging and ultrasound changes of residual lymph nodes from diffuse large B-cell lymphoma (DLBCL) after chemotherapy and their relationship with clinical treatment after chemotherapy.Methods 50 DLBCL patients undergoing full course of chemotherapy but still bearing residual lymph nodes were examined with ultrasound-guided lymph node biopsy.Some examinations were combined with PET-CT to analyze properties of residual lymph nodes.Results 64 lymph nodes were identified by color Doppler ultrasounda in the 50 DLBCL patients treated with full course of chemotherapy.Among them,53 lymph nodes from 42 patients did not show artery blood flow and HE staining of these lymph node biopsy met the clinical standard for complete remission.For the other 11 lymph nodes from 8 patients,ultrasound examination displayed smrounding blood flow inside.At the same time,PET-CT showed that these lymph nodes had higher SUV values,implying high metabolic state in these tissues,which was in agreement with ultrasonic examination results.However,HE staining of these lymph nodes biopsy demonstrated only residual lesion but no tumor tissue.Conclusions Lymph nodes still exist in DLBCL patients treated with full course of chemotherapy.Ultrasound and PET-CT examination have high accuracy in diagnosing benign and malignant residual lymph nodes in follow-up examination on 4 weeks after chemotherapy showed that lymph nodes are over ＞ 1.5 cm in length and have central or peripheral blood flow.Therefore,PET-CT examination of tumor could be considered as a reference index in characterizing residual tumors after chemotherapy.

Objective To evaluate carbon lymph tracer (CH40) in pancreatic cancer surgery.Method 61cases of pancreas head carcinoma undergoing whipple procedure from June 2011 to December 2013 were divided into intraoperative nano carbon group (group A,36 cases),in which resection range was adjusted according to lymph node staining including 13 standard resection cases (group A1),and 23 modified extended radical resection cases (group A2).Standard group (group B,n =17),and extended radical operation group (group C,n =8),respectively.Results The average lymph nodes harvested in group A1 were 25.08 ± 2.72,with positive lymph nodes of 7.92 ± 2.22,significantly more than group B (19.47±1.55,2.68 ±5.24),P＜0.05.In group A2,the average lymph node was 29.91 ±2.68,positive lymph node was 11.04 ± 2.38,significantly more than group C (25.13 ± 2.85,8.49 ± 3.32),P ＜0.05.The mean survival time and overall survival time of group A1 were 43.80 ±4.09 months,51.44 ±1.64 months,significantly more than group B (27.11 ±3.36,41.74 ±3.28 months),P ＜0.05.In group A2,the average tumor free survival time,and overall survival time was 31.58 ±2.99 months,45.02 ±2.54 months,not statistically different with group C (29.13±4.76 month,43.67 ±3.33 months),P ＞0.05.Conclusions Intraoperative lymphatic tracer technology significantly increases lymph node harvest,improving the survival time and tumor free prognosis.

ObjectiveTo study the surgical indications of using locking compression plate (LCP) to fix the posterior pelvic ring fracture,and to explore its surgical techniques.MethodsFrom September 2005 to February 2010,30 patients with posterior pelvic ring fracture were treated with LCP.Among them 21 were males,9 were females,with the average age of 38.7 years(ranged from 21 to 68 years).The injuries were caused by traffic accident in 14 cases,fall-down from high place in 10 cases,smash of heavy object in 6cases.According to Tile classification,4 patients were type B2,8 patients were type B3,12 patients were type C1,5 patients were type C2,and 1 patient was type C3.Concurrent injures including:3 cases with lung contusion; 3 cases with abdominal parenchymatous organs rupture,2 cases with intestinal rupture,5 cases with urethral injury,5 cases with traumatic brain injury,and 8 cases with fractures of limbs,spine and acetabulum.ResultsAll the incisions of 30 patients were healed by first intention.No skin necrosis,fat liquefaction and infection.Thirty cases were followed up from 13 to 40 months,with the average time of 25.1months.According to Majeed functional score system,20 cases were excellent,7 cases were good and 3 cases were acceptable,the excellent and good rate was 90％.Twelve cases got bone healing 3 months after operation,10 cases got bone healing 4 months after operation,and 8 cases got bone healing 6 months after operation.All the cases had no reduction loss,no limb length discrepancy,no deep venous thrombosis,and had not accelerated the previous nerve symptom.ConclusionUsing LCP to fix posterior pelvic ring fracture has many advantages,including wide indication,strong strength of fixation,well biomechanical properties,easy-to-use,and very good follow-up results.

Objective To evaluate the diagnostic value of deep venous thrombosis(DVT)on lowerlimb venous ultrasonography combined with right ventricular dysfunction (RVD) on transthoracic echocardiography(TTE) in patients with acute pulmonary thrombo embolism(PTE). Methods This prospective multicenter control trial included 520 patients with confirmed acute PTE from 41 hospitals between June 2002 and February 2005.Results The incidence of RVD and DVT was associated with the severity of PTE.There were 57.0%(207/363)patients with RVD,49.6%(1 80/363)patients with DVT,265(73.0%)patients with RVD and/or DVT,and 121(33.3%)patients with combined sign of DVT plus RVD in the whole population.As to major PTE population,206(99.5%)patients had RVD and 121 (58.5%)patients had DVT.In addition,the rate of RVD was much greater in proximal PTE than in lobar PTE and segmental PTE(78.7%,51.4%and 21.7%,respectively,P＜0.001).DVT occurred more frequently in proximal PTE than in lobar PTE and segmental PTE(61.7%,46.8%and 37.0%,respectively,P＜O.001).The incidence of the combined sign was 51.1%,24.3%and 8.7%,respenctively (P＜0.001).Conclusions The incidence of the combined sign of RVD plus DVT was associated with the severity of PTE and the localization of emboli.The combined sign of RVD plus DVT help diagnose major PTE especially in emergency department.

OBJECTIVE: To analyze the causes for misplacement of pedicle screw in thoracolumbar spine.METHODS: From January 2002 to January 2008, 19 patients with misplacement in thoracolumbar spine were treated in Department of Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, including 12 males and 7 females with an average age of 52.5 years (range 23-68 years). The diagnoses were thoracolumbar fracture in 5 cases, lumbar spondylolisthesis in 8 and degenerative lumbar disease in 6. The fixation systems were Steffee used in 4 cases, DRFS in 3, RF in 6, AF in 4 and GSS in 2. X-ray and CT scanning were used to observe pedicle screw location, including screw,pedicle and membranous sac and great vessels.RESULTS: The time of misplacement of pedicle screw was 5-69 days with an average time of 18.5 days, including 7 cases of screw penetrating into lateral cortex, 4 of screw penetrating into medial cortex, 2 of screw penetrating into pedicle cortex, 2 of overplacement, 2 of intervertebral foremen placement and 2 of intervertebral space placement.CONCLUSION: The causes for screw misplacement were anatomic variation and poor surgical skills, and the key factors in precise insertion of pedicle screw are fine surgical skills, carefully study of preoperative image and the intra-operative monitoring.

Objective To detect the expressions of COX-2 and VEGF-C in breast cancer and to explore the relationship between their expressions and lymphatic metastasis. Methods Immunohistochemical stai- ning (SABC) was used to detect the expressions of COX-2 and VEGF-C proteins in 60 cases of breast canc- er. Results The positive rate of COX-2 and VEGF-C in breast cancer were 66.7% and 60. 0%, and the expression of COX-2 was positively correlated with VEGF-C (r =0.429, P<0.05). COX-2 and VEGF-C expressions were positively correlated with lymphatic metastasis (P<0.05). The lymphatic metastasis rate in the positive group of COX-2 and VEGF-C were higher than that in the negative group of COX-2 and VEGF-C. Conclusion Over expression of COX-2 and VEGF-C were observed in breast cancer, and closely related to lymphatic metastasis. COX-2 has positive correlation with VEGF-C and was correlated with lym- phatic metastasis of breast cancer. COX-2 may promote the over expression of VEGF-C in tumor cells and cause lymphatic metastasis.

BACKGROUND:Core decompression can delay early osteonecrosis of the femoral head, but cannot completely repair the necrotic femoral head. Eventualy, femoral head colapse, even bone necrosis, wil occur. OBJECTIVE:To explore the curative effect of implantation of gelatin sponge carrying Foxc2-transfected bone marrow mesenchymal stem cels on the repair of experimental femoral head necrosis in rabbits. METHODS:Forty New Zealand white rabbits were selected, and femoral head necrosis models were prepared successfuly in 24 of 40 rabbits. Then, model rabbits were randomized into four groups: blank control group (n=4) with no treatment, core decompression group (n=4), GFP group (n=8) subjected to core decompression and implantation of gelatin sponge carrying GFP-transfected bone marrow mesenchymal stem cels, and Foxc2 group (n=8) subjected to core decompression and implantation of gelatin sponge carrying Foxc2-transfected bone marrow mesenchymal stem cels. At 1, 2, 4 weeks after implantation, ELISA was used to detect Foxc2 protein levels in the transplanted region. At 4, 8, 12 weeks after implantation, MRI scan of the hip was performed, and femoral head tissues were taken and sliced into sections for hematoxylin-eosin staining to observe bone growth. At 12 weeks after implantation, histomorphometry measurement and transmission electron microscope observation were carried out. RESULTS AND CONCLUSION:At 1, 2, 4 weeks after implantation, Foxc2 was highly expressed in the femoral head in the Foxc2 group, which was significantly higher than that in the GFP group. At 4, 8, 12 weeks, only a few of new bone formed in the core decompression group and GFP group; at 12 weeks, fibrous tissues formed in the decompression channel. New bone formation was evident in the Foxc2 group, and at 12 weeks, the necrotic region was repaired completely. MRI findings showed normal femoral head morphology and signals in the Foxc2 group at 12 weeks, but there were decreased signals of the femoral head in the core decompression group and GFP group. These findings indicate that Foxc2-transfected bone marrow mesenchymal stem cel transplantationvia core decompression has good curative effects on experimental femoral head necrosis in animals.

Objective To observe the effect of finger-pressing combined with conventional rehabilitation therapy on the recovery of upper limb function after stroke.Methods A total of 60 cerebral stroke patients were randomly divided into an experimental group (n =30) and a control group (n =30).All patients were treated with conventional anti-symptomatic drugs but no anti-spasticity ones.The experimental group was given conventional rehabilitation and finger-pressing therapy,while the control group was given conventional rehabilitation only.Both groups were measured the motor function,using the upper-extremity portion of the Fugl-Meyer Scale,and the mean integrated electromyography (iEMG) output of biceps and flexor carpi radialis after the first finger-pressing treatment and 1 month later,so as to observe the immediate and continuous effects of finger-pressing therapy respectively.Results After the first session of finger-pressing therapy,the average Fugl-Meyer score(FMA) (12.63 ± 4.64) of the experimental group was significantly higher than in a pretest (12.13 ± 4.88) (P ＜ 0.05),while the iEMG of biceps (41.64 ± 9.22) and flexor carpi radialis (37.06 ± 7.02) were lower than before (P ＜ 0.01).One month after the treatment,compared with the control group,the average FMA (25.17 ± 5.93) and iEMG of biceps(34.42 ± 7.55) and flexor carpi radialis sEMG(30.63 ± 5.54) in the experimental group were significantly improved (P ＜ 0.01).Conclusions Finger-pressing therapy has significant and immediate effects in improving the upper extremity spasticity of stroke survivors.Combined with conventional rehabilitation therapy it can effectively reduce the upper extremity spasticity in stroke patients and significantly improve the upper extremity function.The combination is superior to conventional rehabilitation alone.