Animals ; Estrogens ; metabolism ; Gene Expression Regulation ; Humans ; Osteoarthritis ; complications ; genetics ; metabolism ; Pain ; etiology ; Pain Measurement ; Temporomandibular Joint ; pathology ; Temporomandibular Joint Disorders ; complications ; genetics ; metabolism ; Wnt Signaling Pathway

Objective To evaluate the arc renal parenchyma incision of pelvis within renal sinus and renal posterior lib for the removal of complex staghorn renal calculi.Methods Arc renal parenchyma incision of pelvis within renal sinus and renal posterior lib was performed to remove stones in 86 cases (97 sides) with complex staghorn renal calculi.Among the 86 cases,42 had stones on the right side;33,on the left side;11,on bilateral sides.Seventeen cases had concomitantly calculi in the ureter,and 54 had calculi in upper and mid calyx or multiple renal calculi.As for comorbidity,11 cases had hypertensions;4,diabetes; and 5,hepatitis B.Twenty-five cases had renal insufficiency,with BUN of 12.3 -76.0mmol/L and Cr of 231 -1721?mol/L.The procedure was performed as follows:the kidney was dissected free and the pelvis within renal sinus was isolated.Two rows of bottom style sutures were made on the renal parenchyma with 2-0 plain catgut along mid-lower 1/3 of the dorsal surface of kidney free of vessels from the renal posterior lib to the plane of lower major calyx.The renal parenchyma was opened.Then,the incision was developed from the plane of lower through the middle major calyx to the plane of upper major calyx.The renal parenchyma and mid-low calyx along the incision were opened,suturing while incising,so that all the stones could be easily removed with hook.Results The calculi were completely removed in all 86 cases (97 sides).The opera- tive time was 105-187min ( mean,129min).The intraoperative blood loss was 120-460 ml ( mean,220 ml).Forty-three cases needed intraoperative blood transfusion of 120 -200 ml (mean,140 ml).One month after operation,KUB+IVU and ultrasonic findings were normal with improved hydronephrosis,no intrarenal stricture and no residual calculi.Conclusions This procedure has the advantages of less bleeding,slight impairment of renal function,simple handling,clear operative field,high clearance rate,therefore is indica- ted for the removal of complex staghorn calculi.

Objective Overexpression of SERCA2a could improve cardiac function in human and experimental heart failure(HF)models.We observed the proteomics changes post SERCA2a overexpression in a pacing induced HF model in dogs.Methods Beagles were divided into four groups:control group,HF group(230 beats/min for 4 weeks),HF+EGFP group(myocardial injection of 1 × 1012 v.g recombinant adeno-associated virus carrying enhanced green fluorescent protein gene,rAAV2/1-EGFP)and HF+ SERCA2a group ( myocardial injection of 1 × 1012 v.g recombinant adeno-associated virus carrying SERCA2a gene,rAAV2/1-SERCA2a).Thirty days after gene transduction,left ventficular systolic and diastolic functions were measured by echoeardiography and invasive hemodynamics in all animals.By use of 2-dimensional gel electrophoresis(2-DE),-500 distinct protein spots were detected in myocardium of all animals.Protein spots observed to be altered between failing and SERCA2a overexpressed hearts were subjected to tryptic peptide mass fingerprinting for identification by MALDI-TOF mass spectrometry in combination with LC/MS/MS analysis.Results At 30 day after gene transfer,HF signs were significantly reduced,cardiac function[LVSP:(214.72±31.74)mm Hg(1 mm Hg=0.133 kPa)vs.(139.32±36.79)mm Hg,+dp/dtmax:(6779.43±217.58)mm Hg/s vs.(2746.85±931.23)mm Hg/s and -dp/dtmax:(-4341.42±322.02)mm Hg/s vs.(r-2531.14 ±616.15)mm Hg/s,LVEDP:(21.86±6.95)mm Hg vs.(59.78±6.92)mm Hg]significantly improved in HF+SERCA2a dogs than those in HF+ EGFP group(all P＜0.05)and parameters were comparable between HF+SERCA2a and control groups.We identified alterations in the expression level of more than 10 proteins in myocardium.These protein changes were observed mainly in two subcellular compartments:the cardiac contractile apparatus and metabolism/energetics.Conclusion These results showed that overexpression of SERCA2a could improve cardiac function accompanied with numerous alterations in protein expressions involved in calcium handling,myofibrils,and energy production in this dog model of chronic heart failure.

OBJECTIVETo summarize the experience of lymph node dissection patterns in hand-assisted laparoscopic radical gastrectomy.

METHODSOne hundred and eleven patients with gastric carcinoma between December 2010 and September 2012 were operated by hand-assisted laparoscopic system designed by us. Clinical data were analyzed retrospectively. The lymph nodes were dissected from left to right together with total tumor resection(reverse lymph nodes scavenge pattern), then digestive tract was reconstructed.

RESULTSTotal gastrectomy, distal gastrectomy and proximal gastrectomy were performed in 57, 46 and 8 cases respectively. Combined cholecystectomy and lateral segment of left liver lobe were needed in 4 and 2 patients respectively, and 1 case underwent combined splenectomy and pancreatic body and tail resection. TNM staging of patients in I(, II(, III(A, III(B, and IIII( were 16, 8, 35, 14, and 38, respectively. Histological type was poorly differentiated in 78 cases, moderate differentiation in 26 cases and good differentiation in 7 cases. The incision length was(6.8±0.3) cm, blood loss was(238.4±113.6) ml, operative time was (171.9±23.3) min, number of removed lymph node was 17.2±5.7, hospital stay was (10.1±3.7) d, postoperative complication rate was 9.0%. One case died during perioperative time.

CONCLUSIONSHand-assisted laparoscopic D2 radical gastrectomy(reverse lymph nodes scavenge pattern) can avoid the multiple conversion of open-laparoscopic operation model, and is beneficial to the standardization for surgical procedure.

Gastrectomy ; Humans ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Staging ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

In this paper, we designed to investigate the frequencies of tumor necrosis factor receptor 2 (TNFR2) polymorphisms at nt587 and nt694 in south Chinese SLE patients and healthy individuals and explore whether genetic variants in TNFR2 gene is involved in the pathogenesis of SLE. The results showed that the nt587G allele frequency was 21.1% in the 128 SLE patients and the allele frequency was 13.0% in the 135 healthy individuals, the former was significantly higher than the latter in the allele frequency (P ＜ 0.05). People with the nt587 G variant showed high risk to SLE. The frequency of nt694 was slightly but not statistically significantly increased in SLE patients compared with healthy controls(16.0% versus 11.9%, P= 0.149). These results indicate that the polymorphism at nt587 of TNFR2 is associated with the south Chinese SLE patients. The polymorphism at nt694 is not associated with SLE.

Objective To explore the effects of clinical nursing pathway on patients with total laryngectomy.Methods Totals of 67 cases with total laryngectomy were divided into intensive group(34cases)and control group(33 cases) according to the random number table.Control group received nursing of routine interview before operation and cooperation during operation,while intervention group received clinical nursing pathway,including preoperative interview pathway,operation day support pathway,and postoperative interview Pathway.Many items of two groups were observed such as anxiety situation which measured by Self rating Anxiety Scale(SAS),operation starting time,bleeding during operation,anesthesia recovery time,complication during anesthesia recovery and patients' satisfaction degree.Results The SAS score of intervention group in one day before operation and before anesthesia was (46.37 ±4.78),(49.85 ±5.60),respectively,lower than that of control group ( 50.75 ± 5.82),( 53.96 ± 6.95 ),and the difference was statistically significant ( t =3.371,2.669,respectively; P ＜ 0.01 ).In intervention group,amount of bleeding during operation was (299.63 ±46.71 ) ml,anesthesia recovery time was (26.10 ± 5.08 ) min,hospital stays was ( 15.02 ± 2.74 ) d and patients'satisfaction score was(4.53 ±0.46),lower than that of control group,which in order was( 340.65 ± 59.68 ) ml,(34.50 ± 6.75)min,(19.76 ± 3.62)d,and differences between two groups were statistically significant (t =3.138,3.021,6.055,11.800,respectively;P ＜0.01).Conclusions Implementing surgery clinical nursing pathway for total laryngectomy patients can relive their anxiety,reduce operation staring time and anesthesia recovery time and reduce bleeding amount during operation and the incidence of complication during anesthesia recovery,which had improved therapeutic effect and patients' satisfaction.

Objective To evaluate the effect and safety of low-dose aspirin for primary prevention of cardiovascular events.Methods We searched for randomized controlled trials (RCT) in the following electronic databases:MEDLINE,EMbase,the Cochrane Library (Issue 3,2008),CBM,CNKI.Quality assessment and data extraction were conducted by two reviewers independently.All data were analyzed using Review Manager 4.2.Results Six studies (TPT,HOT,PPP,WHS,POPADAD,J-PAD) involving a total of 72 466 participants met the inclusion criteria.Meta-analysis results showed that:(1) Compared with placebo,the incidences of total cardiovascular events (RR = 0.85,95 % CI:0.80-0.92),stroke (RR = 0.87,95% CI:0.77-0.98),nonfatal stroke (RR = 0.81,95% CI:0.70-0.95) and transient ischemic attack (RR =0.76,95% CI:0.64-0.90) were significantly lower in low-dose aspirin group than those in placebo control group (all P＜0.05).(2) Nonfatal myocardial infarction (RR = 0.89,95 % CI:0.77 -1.02),death from cardiovascular causes (RR =0.98,95%CI:0.86-1.13) and death from any cause (RR =0.95,95%CI:0.88-1.02) were similar between the 2 groups (all P＞0.05).(3) The risk of coronary heart disease was reduced in low-dose aspirin group in the elderly (RR = 0.81,95% CI:0.70-0.94,P＜0.05).(4) The risk of bleeding was higher in low aspirin group compared to placebo group (RR = 1.15,95% CI:1.12-1.18,P＜0.O1).Conclusions low-dose aspirin use could reduce the incidences of total cardiovascular events,stroke,nonfatal stroke and transient ischemic attack but increase the risk of bleeding,the incidence of nonfatal myocardial infarction,death from cardiovascular causes and death from any cause was not affected by low-dose aspirin use.Low-dose aspirin use was also significantly reduced the risk of coronary heart disease in the elderly.

OBJECTIVETo create a standard mini-swine model of chronic ischemic myocardium by endoscopy for the research of gene transfer and stem cell.

METHODSTwenty-three male China experimental minipigs were used, aged from 8 to 11 months with a mean of (9.3 +/- 1.8) months and weighed from 20 to 30 kg with a mean of (29.3 +/- 4.3) kg. The myocardial ischemia was established by gradual occlusion of the left circumflex coronary artery (LCX) with an Ameroid constrictor. The Ameroid constrictor was implanted around LCX by endoscopy. Selective coronary angiography, electrocardiogram and Echo-Doppler study were performed perioperatively to evaluate the degree of stenosis.

RESULTSChronic ischemic myocardial models were successfully generated in 20 of 23 swine by full-endoscopy. Ameroid constrictors were placed at the LCX accurately. Three swine died of anesthetic accident, cardiac arrhythmia at secondary coronary angiography, and pulmonary infection within 6 weeks after operation respectively. Operation time was 25 to 65 min with a mean of (46 +/- 9) min. The blood loss was 30 to 60 ml with a mean of (55 +/- 12) ml. Six weeks later, coronary angiography revealed the total occlusion and partial stenosis (> 85%) of the LCX occurred in 7 and 13 swine respectively. Cardiac systolic and diastolic dysfunction were found in all swine. The ejection fraction value was (65.0 +/- 6.3)% before operation and (41.0 +/- 9.3)% after operation (P = 0.008). The fractional shortening value was (36.2 +/- 4.3)% before operation and (34.2 +/- 2.3)% after operation (P = 0.027).

CONCLUSIONThe endoscopic surgery is a less invasive way to create a standard mini-swine model of chronic ischemic myocardium with effective results.

Animals ; Disease Models, Animal ; Feasibility Studies ; Male ; Myocardial Ischemia ; Swine ; Swine, Miniature ; Thoracoscopes

Background::Clinically amyopathic dermatomyositis (CADM) is a unique sub-type of idiopathic inflammatory myopathies with a high prevalence of interstitial lung disease (ILD). Poor prognosis of the patients was strongly associated with rapid progressive ILD. The aim of this study was to identify risk factors for prediction of different types of ILD in CADM.Methods::In this study, data of 108 inpatients with CADM were collected, including 87 with ILD. The baseline clinical data and laboratory parameters, including myositis-specific and associated antibodies and tumor-associated antigens were analyzed to identify risk factors for acute or subacute interstitial pneumonitis (A/SIP) and chronic interstitial pneumonitis (CIP).Results::In 87 patients with CADM-ILD, 39 (36.1%) were A/SIP, and 48 (44.4%) were CIP. There were 22 (20.4%) patients with asymptomatic ILD who were detected by routine high resolution computed tomography. Cytokeratin-19 fragment (CYFRA21-1) was significantly higher in CADM-ILD than that in CADM patients without ILD; carcinoembryonic antigen and neuron-specific enolase were significantly elevated in A/SIP than that in CIP. Patients with A/SIP had a higher positive rate of anti-melanoma differentiation-associated gene 5 (MDA5), while patients with CIP had a higher positive rate of anti PL-12 and anti-Ro-52. Logistic regression analysis indicated that elevation of CYFRA21-1 was a risk factor for ILD, higher titer of anti-MDA5 indicated increased likelihood for A/SIP, and higher titer of anti-Ro-52 was also clearly associated with CIP.Conclusions::This study indicated that the prevalence of ILD was high in CADM. Asymptomatic ILD has been previously underestimated. Anti-MDA5 was a risk factor for the presence of A/SIP, and CYFRA21-1 was a risk factor for ILD.

Objective To study the effect of electronic daily assessment on the application of standardized training for residents of anesthesiology department. Methods Compared the feedback rate of the previous paper evaluation form and the electronic daily evaluation submission,and summarized the results of the daily evaluation of residents of different grades and different sources through the electronic system. Results The feedback rate of the paper form and the electronic for was 59.5% and 96.7% separately. Comparing the scores of different grads, the total score and sub option scores gradually increased from grade one to grade three. The lowest score of sub options in all grades were anesthetic plan/crisis management scores. The worst overall rating(performance worse than expected)happened in the second-year residents. The best overall rating(performance better than expected) happened in the third-year resident. The residents form other hospitals had higher scores than PUMCH(Peking Union Medical Col-lege Hospital)'s residents and graduate students except for the score of theoretical knowledge. The PUMCH's resi-dents got lower score in overall rating.The teaching staff rescheduled and modified the training program according to the educational defect,so as to individualize resident training. Conclusions The daily electronic assessment helps to monitor daily performance of residents in a timely and comprehensive manner, so to adjust teaching methods, and contributes to conduct formative evaluation,which has a positive impact on improving teaching effectiveness.