Aim To investigate the relationship between the clinical actions and the serum concentrations of the enantiomers of (?)-trans tramadol and its active metabolite. Methods 20 postoperative patients were divided into two groups and given multiple intravenous doses of (?)-trans tramadol hydrochloride injection, 400 mg?d-1 (group A) or 300 mg?d-1 (group B). The blood samples were taken at 38 h after the initial dose. The concentrations of the enantiomers of (?)-trans tramadol and its active metabolite, (?)-trans O-demethyltramadal were determined with high performance capillary electrophoresis(HPCE). Results The concentrations of the enantiomers of (?)-trans tramadol, the frequency and serious level of adverse reactions were higher in group A than in group B. The concentrations of the enantiomers of (?)-trans O-demethyltramadal, the analgesic effect were similar between group A and group B. Conclusion There is much closer relation between the analgesic effect and the concentration of (+)-O-demethyltramadal. The frequency and serious level of adverse reactions may be attributed to the higher concentrations of the enantiomers of (?)-trans tramadol, which are caused by the saturated metabolism.

Background Researches documented that retinal nerve fiber layer thickness (RNFLT) in unaffected carriers of Leber hereditary optic neuropathy (LHON) becomes thickened in different quadrants to different degrees.But the change of their macular thickness is still unclear.Objective This study was to clarify RNFLT and macular thickness by optical coherence tomography (OCT) in unaffected female carriers of LHON families.Methods Five female LHON patients (5 eyes) from 5 LHON families,eighteen unaffected female carriers (18eyes) from 18 LHON families and twenty-five age-matched healthy female controls (25 eyes) were included in this study.The patients and genetic carriers were diagnosed in PLA General Hospital from 2011 September to 2012 October.Regular ocular examination were performed followed by OCT measurement of retinas.The Optic Disc Cube 200×200 and Macular Cube 200×200 protocols were used during the OCT measurement.Average (360°) RNFLT,RNFLT at four quadrantic sections,cube average macular thickness and macular thickness of nine Early Treatment Diabetic Retinopathy Study (ETDRS) sub-areas were compared among the LHON genetic carriers,LHON patients and normal controls.Results Compared to the normal control group,significant reduced values were seen in temporal,superior,nasal and inferior side of sub-area macular thickness in the LHON female carriers (P=0.022,0.046,0.024,0.008).In addition,but no significant differences were found in cube average thickness,central subarea macular thickness,temporal,superior,nasal and inferior side of lateral sub-area macular thickness,average RNFLT,and temporal,superior,nasal and inferior quadrant RNFLT between the LHON female carriers and normal controls (P=0.102,0.051,0.238,0.663,0.1 10,0.104,0.419,0.371,0.158,0.063,0.563).Compared to the unaffected female carrier group,female patients showed significant reductions in cube average macular thickness,temporal,superior,nasal and inferior side of sub-area macular thickness,temporal,superior,nasal and inferior side of lateral sub-area mac ular thickness,average R NFLT and temporal,superior,and inferior quadrant RNFLT (P =0.000,0.000,0.000,0.007,0.002,0.002,0.000,0.000,0.040,0.000,0.016,0.000,0.000) except for the central subarea macular thickness and nasal quadrant RNFLT (P=0.388,0.580).Conclusions Unaffected LHON female carriers show a normal peripapillary RNFLT,but the macular thickness at medial sub-area is thinner.This first report offers an information of macular structure change in unaffected LHON female carriers,which suggest that macular damage appears prior to RNFLT change.

Objective To investigate the evaluation significance of plasma D-dimer level for the prognosis in acute exacerbation of chronic obstructive pulmonary disease(AECOPD) excluding pulmonary embolism(PE).Methods The patients with AECOPD were collected from the respiration department and emergency internal medicine department of the Affiliated Hospital of Nantong University during 2007-2011.Thirty-five AECOPD cases of D-dimer positive and excluding PE and lower extremity deep venous thrombus(DVT)by CT angiography served as the experimental group and 35 cases of D-dimer negative as the control group.The differences in the first time hospitalization duration,GOLD grade,mortality rate,re-hospitalization times within 4 years,times of admission to ICU,times of intracheal intubation,rehospitalization and outside-hospital mortality rate were compared between the two groups.The receiver operatingcharacteristic(ROC)curve was applied to evaluate the short-term and long-term prognostic capacity of D-dimer.The t test at the follow up end point was used to analyze the D-dimer level in the death group and the survival group.Results The D-dimer level,length of hospital stay,death number of first time hospitalization,times of re-hospitalization,times of admission to ICU,times of intubation,re-hospitalization and outside-hospitalization mortality rate and total mortality rate had statistical differences between the experimental group and the control group(P＜0.05);but the differences in the age,gender and GOLD grade between the two groups had no statistical significance(P＞0.05).The sensitivity of D-dimer＞1 165 μg/L for predicting the death number of the first time hospitalization was 87.5 ％,and the specificity was 80.6 ％.The sensitivity of D-dimer＞ 865μg/L for predicting the mortality rate of re-hospitalization and outerside-hospital was 78.9 ％,and the specificity was 74.5 ％.The survival curve graph during the follow up period in the two groups revealed that the survival time and survival rate had statistical difference between the two groups.The D-dimer level in the death group was significantly higher than that in the survival group with statistical difference(P＜0.05).Conclusion The D-dimer level is an independent risk factor affecting the short-term and longterm prognosis of AECOPD.

· AIM :To investigate the role of pericytes in growth of retinal microvascular endothelial cells with a co-culture system in order to understand some mechanism of angiogenesis in hypoxia induced retinal neovascular disorders.(RMECs) were isolated by a modified protocol using CD31 coated Dynabeads, and identified by immunocytochemical staining with anti-Factor Ⅷ and CD31 antibodies. Rat retinal pericytes were isolated and characterized by immunofluorescent staining with PDGFR-β; and desmin antibodies. Pericytes and RMECs were cultured in a contact co-culture system both under normoxia and hypoxia by Millicell chamber. RMECs proliferation was evaluated by MTT and cell cycle assay with flow cytometry. RT-PCR was used to detect the alteration of KDR/Flk-1 mRNA level in RMECs under normoxia or hypoxia in the co-culture system.harvested with the modified isolating method. The two cell types were identified by positive Factor Ⅷ, CD31 and PDGFR-β, desmin cytochemical staining respectively.RMECs proliferated significantly under hypoxia from 3 to 9d with a maximal rate on day 6 (24.9%, P ＜ 0.01) by MTT. In the co-culture system, the proliferation of RMECs was inhibited by pericytes. After 6d exposure to hypoxia,the fraction of S-phase RMECs number was greatly increased by 43.9% (P ＜ 0.01). In the co-culture system,RMECs proliferation was inhibited by pericytes through decreasing the fraction of S-phase cell number both under normoxia (3.6%, P＜0.05) and under hypoxia (15.1%,P＜0.01). KDR/Flk-1 mRNA level in single cultured RMECs was shown to increase approximately 1.3-fold when exposed to hypoxia. Compared with single cultured RMECs, co-culture with pericytes could decrease KDR/Flk-1 mRNA by 45.1% (P＜0.05) and 27.7% (P ＜ 0.05) under normoxia and hypoxia condition respectively.pericytes could inhibit proliferation of RMECs under both normoxia and hypoxia. The inhibition effects of pericytes maybe, at least in part, due to downregulation of KDR/Flk-1 of RMECs. These findings confirm that pericytes could be a potential inhibitor in the pathogenesis of retinal neovascularization.

Objective To investigate the causes of arterial reocclusion in diabetic feet patients after endovascular treatment and its remedial measures.Methods From January 2009 to October 2013,clinical data of 371 arterial reocclusion of diabetic feet patients after endovascular treatment in Tianjin First Central Hospital were reviewed retrospectively.We summarized the causes of reocclusion,treatment methods and the short term results.Results According to the Trans-Alantic Inter-Society Consensus (TASC) Ⅱ grading standards,the first time when the endovascular treatment started there were 37 cases of grade A,85 cases of grade B,143 cases of grade C,106 cases of grade D.Arterial re-occlusion developed from one day to 36 months,averaging at (21 ± 8) months.Causes of re-occlusion included intimal hyperplasia in 263 cases (70.9％),thrombosis in 65 cases (17.5％),dissection in 19 cases (5.1％),stent fracture in 17 cases (4.6％),vascular rupture in 7 cases (1.9％).Remedial therapy adopted for arterial reocclusion was repeated endovascular treatment in 327 cases (88.1％),arterial bypass surgery in 23 cases (6.2％),conservative treatment in 13 cases (3.5％),amputation (cut toe) in 4 cases (1.1％),4 cases (1.1％) died perioperatively.275 cases were followed up for 1 to 36 months,the average was (13 ± 8) months.patency rate was 82.9％,71.3％ and 63.0％ at 6 months,1 year and 2 years.Amputation rate was 1.1％,1.8％ and 2.5％ at 6 months,1 year and 2 years.Conclusions Intimal hyperplasia is to blame for arterial reocclusion after endovascular treatment of diabetic foot.In this case most patients still can benefit from second time endovascular treatment,with a satisfactory short term patency rate.

Objective To investigate the clinical value of preoperative serum carcinoembryonic antigen (CEA) detection in the prediction of esophageal cancer lymph node metastasis.Methods The clinical data of 111 patients with esophageal cancer who were admitted to the Chaoyang Hospital of Capital Medical University between December 2010 and January 2014 were retrospectively analyzed.Patients received preoperative serum CEA examination and enhanced CT of the chest.The surgical procedures were selected according to the condition of patients, including radical resection of esophageal cancer via left thoracic approach, transabdominal right thoracic approach (open and laparoscopic surgeries), cervico-thoracic-abdominal triple incision (open and laparoscopic surgeries) and transabdominal incision.The international standard was used for tumor location and TNM stage of esophageal cancer.The count data and comparison of ordinal data in the univariate analysis were analyzed using the chi-square test, Fisher exact probability and rank-sum test, respectively.The multivariate analysis was done using the stepwise logistic regression.The ROC curve was used for evaluating diagnostic value of serum CEA examination and enhanced CT of the chest.All the 111 patients were divided into 4 groups according to the interquartile range results of the CEA examination, and the lymph node metastasis rates of 4 groups were compared by the chi-square test.Results All the 111 patients underwent successful radical resection of esophageal cancer after preoperative serum CEA detection and enhanced CT of the chest, including 40 via left thoracic approach, 56 via transabdominal right thoracic approach, 8 via cervico-thoracic-abdominal triple incision and 7 via transabdominal incision.There were 3 patients with upper thoracic esophageal cancer, 52 with middle thoracic esophageal cancer, 36 with lower thoracic esophageal cancer and 20 with cancer of gastro-esophageal junction.The postoperative pathological type included 84 squamous cell carcinomas, 23 adenocarcinomas and 4 other carcinomas.There were 44 patients with negative lymph node metastases and 67 with positive lymph node metastases.The positive rate of elevated serum CEA in the 111 patients was 36.04％ (40/111).Tumor location, pathological type and N stage of tumor were clinical pathological factors affecting the positive rate of serum CEA of patients (Z =6.815, 6.608, 16.928, P ＜0.05).N stage of tumor was an independent risk factor affecting the positive rate of serum CEA of patients by multivariate analysis [OR =2.206, 95％ confidence interval (CI) :1.370-3.552, P ＜ 0.05].The T stage of tumor and serum CEA level were risk factors affecting lymph node metastasis of esophageal cancer by univariate analysis (Z =18.971, x2=10.081, P ＜0.05), and those were also independent risk factors affecting lymph node metastasis of esophageal cancer by multivariate analysis (OR =3.558, 3.936, 95％ CI: 1.798-7.041, 1.480-10.469, P ＜0.05).The lymph node metastasis rates of esophageal cancer were 46.43％, 48.28％ , 55.56％ and 92.59％ when CEA level≤ 1.75 μg/L, 1.75 μg/L ＜ CEA level ≤ 2.68 μg/L, 2.68 μg/L ＜ CEA level ≤4.21 μg/L and CEA level ＞ 4.21 μg/L by the stratified analysis, respectively, with a significant difference among the 4 groups (x2=16.026, P ＜ 0.05).The areas under the curve of CEA level and enhanced CT of the chest for lymph node metastasis were 0.687 (95％ CI: 0.590-0.785) and 0.689 (95％ CI: 0.591-0.788) by ROC curve, which were significantly different from the area under the guides (P ＜0.05).The areas under the curve of CEA level and enhanced CT of the chest for lymph node metastasis were 0.785 (95％ CI: 0.697-0.873, P ＜ 0.05).Conclusions Serum CEA detection not only has certain predictive value for lymph node metastasis of esophageal cancer, but has a higher predictive value combined with enhanced CT of the chest.There is a risk of lymph node metastasis for patients with deep tumor invasion and elevated CEA level, and the range of lymph node dissection should be expanded.

Objective To investigate the association between elevated levels of hsCRP and prognosis after stroke in Chinese patients.Methods Two hundred and ninety consecutive patients with firstonset stroke(197 ischemic and 93 hemorrhagic)and 290 age-and sex-matched control subjects without any cerebrovascular disease were studied.Plasma hsCRP level was measured and subsequent vascular events and death were determined in both groups over a 5-year period.Results Compared to control group,patients with stroke had higher plasma hsCRP level((3.3 ±3.8)vs(1.3±2.2)mg/L,t=8.048,P<0.01).Furthermore.within the group of patients with stroke,the mean plasma hsCRP level was higher in patients who experienced subsequent vascular events or death compared to patients without further complications ((4.4±4.3)vs(2.7±3.3)mg/L,t=3.496,P=0.001).Compared to the patients with lower hsCRP level(<1 mg/L),the relative risk for vascular events and death in stroke patients was 2.807(95%CI 1.544-5.495,P=0.001)in the hish hsCRP(>3 mg/L)patients.This increase of relative risk for vascular events and death in stroke patients persisted after the adjustment for age,sex and other cardiovascular risk factors such as hypertension and diabetes(OR 2.661,95%CI 1.323-5.352.P=0.006).Conclusions Patients presenting with stroke have higher levels of hsCRP compared to agematched controls.The degree of hsCRP elevation is correlated with the likelihood of subsequent VasCular events and death.These findings indicate that inerease of hsCRP level is associated with worsening prognosis after stroke in Chinese patients.

Objective To explore the clinical efficacy and satety of LFK-SLT30 semiconductor laser combined with polidocanol for the treatment of varicose veins of the lower extremities.Methods The clinical data of 105 patients treated by traditional surgery (surgery group) and 113 patients with endovascular laser treatment (EVLT) combined with polidocanol (combination group) were retrospectively analyzed from Apr 2013 to Apr 2015.Results The operative time [(50 ± 12) min vs.(70 ±10)min] and blood loss [(19 ± 6)ml vs.(41 ± 8)ml] between combination group and surgery group were significantly different (P ＜ 0.05).The rate of complications in surgery group was significantly higher than that in the combination group[15.2％ (16/105)vs.6.3％ (7/113),x2 =4.717,P =0.030].The overall 1',2' and 3 year follow-up rate was 85.3％ (186/218),76.6％ (167/218),and 60.6％ (132/218).The average follow up was (20 ± 13)months.No significant difference existed in the rate of recurrence [0 vs.3.5％(4/113),x2 =3.786,P=0.123] between the two groups.Conclusions EVLT combined with foam sclerotherapy is as effective as surgery,while resulting in less complications,less invasive,safer and more effective for the treatment of varicose veins of the lower extremities.

Objective To verify the accuracy of the mathematical model of gastrointestinal decompression after esophagectomy of esophageal cancer and explore predictive value of the mathematical model in the postoperative complications.Methods The retrospective case-control study was conducted.The clinicopatholo gical data of 192 patients with esophageal cancer who underwent esophagectomy in the Beijing Chaoyang Hospital of Capital Medical University between October 2013 and October 2016 were collected.Among 192 patients,160 didn't have postoperative complications and 32 had postoperative complications (7 with postoperative anastomotic leakage,9 with pulmonary infection and 16 with dysfunction of gastralintestinal tract).Patients selected the appropriate surgical procedures according to individual conditions,and then volume of gastrointestinal decompression was recorded daily.According to the regression equation of influencing factors of volume of postoperative gastrointestinal decompression:average daily drainage volume within 5 days (mL)=262.287 + 132.873 × tubular stomach-72.160 × smoking history-27.904 × pathological type of tumor-36.368 × age,predictive value of postoperative gastrointestinal decompression was calculated and compared with real volume of gastrointestinal decompression.Observation indicators:(1) comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients without complications;(2) comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients with complications.Measurement data with normal distribution were represented as (x)±s and comparison was analyzed using the pairedsamples t test.Measurement data with skewed distribution were described as M (range),and comparison was analyzed using the Wilcoxon signed rank tests.Results (1) Comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients without complications:predictive value and real volume of postoperative gastrointestinal decompression in 160 patients without complications were respectively 187 mL (range,58-392 mL) and 207 mL (range,20-570 mL),with no statistically significant difference (Z=-1.106,P＞0.05).(2) Comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients with complications:7 patients had postoperative anastomotic leakage,including 1 with cervical anastomotic leakage and 6 with chest anastomotic leakage.The predictive value and real volume of postoperative gastrointestinal decompression in 7 patients with anastomotic leakage were respectively (215±58)mL and (338± 106)mL,with a statistically significant difference (t=-3.139,P＜0.05).The predictive value and real volume of postoperative gastrointestinal decompression in 9 patients with postoperative pulmonary infection were respectively (176±61) mL and (239± 111) mL,with no statistically significant difference (t =-1.805,P＞0.05).The predictive value and real volume of postoperative gastrointestinal decompression in 16 patients with dysfunction of gastralintestinal tract were respectively (236 ± 60) mL and (357 ± 107) mL,with a statistically significant difference (t =-4.716,P＜ 0.05).Conclusions The mathematical model of gastrointestinal decompression after esophagectomy of esophageal cancer is correct and feasible.There is a predictive value for patients with postoperative anastomotic leakage and dysfunction of gastralintestinal tract.

The paper presented the thoughts and steps taken by the National Center for Cardiovascular Diseaes in biobank quality management system.By means ofprocess approach,the organizational structure,identification and analysis process were established,along with the management mechanism and normalized documentation.Centering onPlan,Do,Check and Act(PDCA),a complete set of quality management system was established.This system enables normalized management of biobanks in China,and provides practice guidelines for development industry standards of the country as well.