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.

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 assess the feasibility and accuracy of transesophageal echocardiography (TEE) in screening patients,intraoperative guidance of occluder releasing and efficacy assessment in the patients of percutaneous left atrial appendage (LAA) occlusion with Watchman.Methods Ultrasonic instrument Philips iE33(proble model X7-3t) were used to measure the maximum diameter and the depth of LAA ostium in enrolled patients by TEE,and intraoperative guided puncture of interatial septum,positioning Watchman transmission system and instruction closure release under TEE,immediate evaluate the postoperative therapeutic effect and record the complications by TEE.At 45 days after implantation,patients should repeat TEE to assess the efficacy.Results Eighteen patients underwent device implantation.Seventeen patients implant successfully,except one patient can't implant device beacuse of the LAA morphologe was not suitable.There was one patient showing thrombus formation on the surface of device,one patient of LAA and the device axial angulation was 90 °.At 45 days after implantaion,16 patients were fullowed up,there were no major stroke at all.Conclusions TEE has important application value in screening of preoperative patients,intraoperative guidance of occluder releasing and efficacy assessment in the patients of percutaneous left atrial appendage occlusion with Watchman.

Objective To evaluate right ventricular function of chronic thromboembolic pulmonary hypertension (CTEPH) patients by echocardiography and cardiac magnetic resonance (CMR),and to evaluate the value of clinical application of those right heart function indexes.Methods 32 patients with CTEPH who underwent CMR and echocardiography were involved in the study.Right ventricular index of myocardial performance (RIMP),fractional area change (FAC),tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler-derived tricuspid lateral annular systolic velocity (S') were measured by echocardiography.Right ventricular end-diastolic volume (RVEDV) and end-systolic volume (RVESV) were measured by cardiac magnetic resonance and right ventricular ejection fraction (RVEF) was calculated.Results A positive correlation was found between FAC and RVEF (r =0.423,P =0.022),there was a negative correlation between RIMP and RVEF (r =-0.387,P =0.048),there was no correlation between TAPSE and RVEF (r =0.451,P =0.22),a positive correlation was found between S' and RVEF (r =0.689,P =0.000).Conclusions The echocardiographic parameters FAC,RIMP and S' can reflect right ventricular function in patients with CTEPH and can be used as a routine clinical parameters.

Objective To evaluate right ventricular systolic function in patients with pulmonary hypertension (PH) by real-time three-dimensional echocardiography (RT-3DE),and compared with cardiac magnetic resonance.Methods A total of 23 patients with PH who underwent MRI and echocardiography in the study.Right ventricular index of myocardial performance (RIMP),fractional area change (RVFAC),tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler-derived tricuspid lateral annular systolic velocity (S') were measured by echocardiography.RV end-diastolic volume (RVEDV) and endsystolic volume (RVESV) were measured by RT-3DE and cardiac magnetic resonance and RV ejection fraction (RVEF) was calculated.Results A positive correlation was found between RVFAC and RVEF (r =0.595,P =0.003),there was a negative correlation between RIMP and RVEF (r =-0.745,P =0.000),has no correlation between TAPSE and RVEF (r =-0.029,P =0.896),a positive correlation was found between S' and RVEF (r =0.489,P =0.018).There were close correlation between RVEDV,RVESV and RVEF measured by RT-3DE and MRI (P ＜0.001,respectively);Bland-Altman analyses showed good agreement between them.Conclusions RT-3DE can noninvasive,accurate assessment right ventricular systolic function in patients with PH,and provide prognosis and treatment choice for clinical demands.

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.

In order to survey antibiotic resistance of clinical isolates carbapenem-resistant A cinetobacter baumannii in Meizhou and to investigate resistance mechanism and molecular epidemiological characteristics ,a total of 210 non-duplicated clinical isolates of carbapenem-resistant Acinetobacter baumannii from January 2012 to December 2012 were collected .The K-B disk diffusion method was applied for the drug-susceptibility test ,a modified Hodge test was used for the screening of carbapen-emase ,PCR was used to amplify carbapenemase genes (including IMP ,VIM ,OXA-23 ,OXA-24 ,OXA-51 and OXA-58) ,and the positive products were sequenced .Enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) was used for DNA typing and test of homology .Our results on the percentage of strains resistant for antibiotics tested were higher than 60% except for polymyxin B was 0 .48% .There were 163 positive strains by the modified Hodge test ,accounting for 77 .62% .OXA-51 gene was identified in 198 strains (94 .29% ) ,OXA-23 in 165 strains (78 .57% ) ,and VIM in 9 strains (4 .29% ) ,OXA-24 ,OXA-58 and IMP gene was not identified by PCR amplification .Seven genomic types were included in the 210 carbapenem-resistant Acinetobacter baumannii .The major prevalence types were Type A (97 strains) ,Type B (44 strains) and Type H (25 strains) . In conclusion ,multiple drug resistance of clinically isolated carbapenem-resistant A cinetobacter baumannii is a serious problem in Meizhou .Production of OXA-51 ,OXA-23 and IMP carbapenemases is an important mechanism of resistance to carbapenem antibiotics ,and there is prevalence of the same clones in these carbapenem-resistant strains .