Objective To investigate the mechanism and effect of the spinal cord outlet of the skull base on Chiari Ⅰ malformation with syringomyelia.Methods The cervical spinal cord stem angle (Anbc),slope angle of cervical vertebra (Ansc) of Chiari Ⅰ malformation were measured.In foramen magnum (Llf) and anterior vertebral canal level (Laf),spinal canal(Ac),spinal cord (As) and inferior hernia area (Ah) were measured.Angle,area and ratio were compared in Chiari Ⅰ malformation with syringomyelia,Chiari Ⅰ malformation without syringomyelia and normal control group.Results Ansc,Anbc-Ansc had significant differences among control group and Chiari Ⅰ malformation patients (all P＜0.001).In Llf,Laf,As had significant differences among three groups (all P＜0.05),further comparison of the two showed there were significant differences between Chiari Ⅰ malformation with syringomyelia patients and control group,Chiari Ⅰ malformation without syringomyelia patients and control group in Llf(all P＜0.05).In Llf,Laf,Ac in Chiari Ⅰ malformation with syringomyelia was smaller than control group (P＜0.05).Ah in Llf,Lafand Lh in Llf had no statistical significant difference between Chiari Ⅰ malformation with and without syringomyelia patients (all P＞0.05).In Llf,Laf,As/Ac had statistical significant difference among Chiari Ⅰ malformation with and without syringomyelia patients,control group (all P＜0.001),further comparison of the two showed As/Ac in Llf had statistical significance difference between Chiari Ⅰ malformation with syringomyelia patients and control group (P＜0.05),As/Ac in La had statistical significance difference between Chiari Ⅰ malformation with syringomyelia patients and control group,between Chiari Ⅰ malformation without syringomyelia patients and control group (all P＜0.05),Conclusion The cervical spinal cord,Ansc reducing,narrow vertebral proportion increase are important factors to promote Chiari Ⅰ malformation syringomyelia.

From the three perspectives, skin stress response, medication-acupoint effect and neuroendocrine-immune system, this article discussed the action mechanism of vesiculation moxibustion therapy, to provide scientific evidence for the development of this therapy and to enhance its therapeutic efficacy.

BACKGROUNDThe most appropriate surgical approach for patients with post-infarction left ventricular (LV) aneurysm remains undetermined. We compared the efficacy of the linear versus patch repair techniques, and investigated the mid-term changes of LV geometry and cardiac function, for repair of LV aneurysms.

METHODSWe reviewed the records of 194 patients who had surgery for a post-infarction LV aneurysm between 1998 and 2010. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed. LV end-diastolic and systolic dimensions (LVEDD and LVESD), LV end-diastolic and end-systolic volume indexes (LVEDVI and LVESVI) and LV ejection fraction (LVEF) were measured on pre-operative and follow-up echocardiography.

RESULTSOverall in-hospital mortality was 4.12%, and major morbidity showed no significant differences between the two groups. Multivariate analysis identified preoperative left ventricular end diastolic pressure > 20 mmHg, low cardiac output and aortic clamping time > 2 hours as risk factors for early mortality. Follow-up revealed that LVEF improved from 37% pre-operation to 45% 12 months post-operation in the patch group (P = 0.008), and from 44% pre-operation to 40% 12 months postoperation in the linear group (P = 0.032). In contrast, the LVEDVI and LVESVI in the linear group were significantly reduced immediately after the operation, and increased again at follow-up. However, in the patch group, the LVEDVI and LVESVI were significantly reduced at follow-up. And there were significant differences in the correct value changes of LVEF and left ventricular remodeling between linear repair and patch groups.

CONCLUSIONSPersistent reduction of LV dimensions after the patch repair procedure seems to be a procedure-related problem. The choice of the technique should be tailored on an individual basis and surgeon's preference. The patch remodeling technique results in a better LVEF improvement, further significant reductions in LV dimensions and volumes than does the linear repair technique. The results suggest that LV patch remodeling is a better surgical choice for patients with post-infarction LV aneurysm.

Aged ; Female ; Heart Aneurysm ; etiology ; mortality ; surgery ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; surgery ; Ventricular Remodeling

OBJECTIVETo compare the morphometry and endothelial nitric oxide synthase (eNOS) expression of radial artery (RA) between young and elderly patients with coronary atherosclerotic heart disease.

METHODSFrom February 2008 to June 2009, 219 patients underwent coronary artery bypass grafting (CABG) with autologous RA, 57 patients aged beyond 70 years and 64 patients aged under 60 years. Before RA was harvested, a modified Allen test was routinely performed. If positive, RA would be further evaluated with Doppler ultrasound examination. In both groups RA was collected for HE staining to evaluate percentage of luminal narrowing (LN) and relationship between intima and media width at maximum intimal thickness (IMR). Immunofluorescence and Western blot were used to investigate the location and expression level of eNOS within the wall of RA.

RESULTSMorphometry of RA in both young and elderly patients represented mild or moderate intimal hyperplasia, and medial calcification was not found. LN in elderly patients was (22 ± 6)%, while in young patients, it was (23 ± 6)%. IMR in elderly patients was 0.36 ± 0.21, while in young patients, it was 0.42 ± 0.19. There was no significant difference in both LN and IMR between two groups (P > 0.05). Immunofluorescence indicated RA in both groups revealed a high expression of eNOS in intima and media, particularly in the smooth muscle of media. The values of relative integrated optical density in elderly patients was 1.21 ± 0.13, while in young patients, it was 1.25 ± 0.12. Also there was no significant difference in the expression level of eNOS within the wall of RA (P > 0.05).

CONCLUSIONAfter preoperative assessment with modified Allen's test and Doppler analysis, RA used as graft in the elderly has similar quality and function with young patients, and it may lead to a high patency in long term.

Aged ; Coronary Artery Bypass ; Coronary Artery Disease ; enzymology ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Nitric Oxide Synthase Type III ; metabolism ; Radial Artery ; enzymology ; pathology

OBJECTIVETo retrospectively summarize and analyze the short and mid term follow-up outcomes of combined coronary artery bypass grafting (CABG) and restrictive mitral annuloplasty in curing ischemic cardiomyopathy and ischemic mitral regurgitation (IMR), and to study its effect on reverse left ventricular remodeling.

METHODSFrom January 2000 to June 2008, 111 patients of coronary artery disease with moderate to severe IMR underwent combined CABG and restrictive mitral annuloplasty, downsizing by 1-2 ring sizes. There were 81 male and 30 female patients. The age ranged from 36 to 83 years with a mean of (63 ± 18) years. Preoperative transthoracic echocardiography showed minimal to moderate IMR in 7 cases, moderate to severe in 65 cases and severe in 39 cases. The left arterial diameter (LAD) was (58 ± 6) mm, left ventricular end-diastolic diameter (LVEDD) was (61 ± 8) mm, left ventricular ejection fraction (LVEF) was 46% ± 6%. Serial studies were performed to assess the survival rate, the extent of mitral regurgitation (MR), LVEF, the leaflet coaptation height, LAD, LVEDD, New York Heart Association (NYHA) functional class.

RESULTSHospital mortality was 2.7% (3 cases). Each case received an undersized ring. Intraoperative transesophageal echocardiography showed that no regurgitation in 69 cases, minimal in 34 cases, minimal to moderate in 5 cases, moderate to severe in 3 cases which received mitral valve replacement. The 3-, 12- and 24-month survival rate was 96.2%, 93.5% and 89.7% respectively. Mitral regurgitation grade decreased after the operative procedure (P < 0.01). LVEF increased from (46 ± 6)% to (53 ± 6)% (24 months follow-up) (P < 0.01). LAD decreased from (58 ± 6) mm to (46 ± 6) mm (24 months follow-up) (P < 0.01). LVEDD decreased from (61 ± 8) mm to (48 ± 10) mm (24 months follow-up) (P < 0.01). There was no significant decline of LVEDD in 18 cases (16.2%) whose preoperative mean LVEDD was (69 ± 9) mm. NYHA functional class improved after operative procedures (P < 0.01). At 24 months follow-up, 2 cases received valvular replacement.

CONCLUSIONSCombined CABG and restrictive mitral annuloplasty is a feasible and effective treatment for IMR, the short and mid term outcomes are satisfactory, and a significant reduction of LVEDD and an increase of LVEF due to reverse ventricular remodeling were observed.

Adult ; Aged ; Aged, 80 and over ; Coronary Artery Bypass ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve Annuloplasty ; methods ; Mitral Valve Insufficiency ; surgery ; Myocardial Ischemia ; surgery ; Retrospective Studies ; Treatment Outcome ; Ventricular Remodeling

Objective: This study aims to investigate the menarcheal age of female junior middle school students in Tianjin and associated factors, providing suggestions for further development of adolescence education on physiological and mental health. Methods: A total of 4 127 junior middle school girls in Tianjin area were selected by stratified random sampling method, and investigated by the method of physical examination and questionnaire survey, results were analyzed. Results: There were 1 383 girls reported menarche. Mean age at menarche was(12.68±1.19) years old; One-way ANOVA showed that girls with higher family income, higher parental education had earlier menarcheal age(F=4.97, 9.52, 10.64, P<0.05). It showed that the tendency that obesity group and over-weight group was higher in the rate of menarche than that of normal group and marasmus group(F=4.20, P<0.05). However, different time on watching TV, computer or celephone and sleeping was found to be unrelated with age at menarche(P>0.05). Kruskal Wallis H test showed that girls whose mothers’ AAM was earlier had earlier menarcheal age(H=82.94, P<0.05). According to age, girls were divided into groups of 10-11, 11-12, 12-13 and 13-14 years old. Girls in each age group were divided into the menstruation menarche group and the non-menstruation menarche group. The results showed that the levels of height, weight, BMI, waist circumference, hip circumference, and the skin fold thickness in menstruation group were higher than those in non-menstruation group(t=2.18-10.93, P<0.05). After that, girls of each group were divided into four group：marasmus group, the normal group, the over-weight group and the obesity group according to BMI(χ2=34.66，13.37，11.09，12.60,P<0.05). Conclusion Female junior middle school students’ menarcheal age in Tianjin is related to family income, parents’education, mother’s age at menarche, obesity and physical exercise frequency.

Objective To investigate the relationship between hemoglobin and blood pressure of pregnant women in Zhoushan islands, so as to provide scientific evidence for the etiological study of gestational hypertension. Methods A retrospective study was conducted among 1 383 pregnant women who received perinatal care in Zhoushan Maternal and Child Health Hospital of Zhejiang Province from January 2017 to June 2018. Pregnant women were monitored for hemoglobin content and blood pressure in the early, middle and late pregnancy. The multivariate linear regression was used to analyze the relationship between hemoglobin content and blood pressure in different pregnancy. Results The incidence of anemia in early, middle and late pregnancy was 7.74%, 25.45% and 15.76% respectively. The multivariate linear regression showed that hemoglobin levels during pregnancy had effects on systolic blood pressure in early, middle and late pregnancy, and the earlier hemoglobin levels were monitored, the more obvious the effect on systolic blood pressure was.With the increase of hemoglobin level, systolic blood pressure increased, such as the effect of hemoglobin on systolic blood pressure in early pregnancy, mid-pregnancy and late pregnancy. Hemoglobin of first trimster had the greatest effect (β=0.10, P<0.001), Hemoglobin of second trimester had no obvious effect, and that of third trimester had the second effect (β=0.04, P=0.027).Hemoglobin levels and diastolic blood pressure levels were similar to their relationship with systolic blood pressure. Conclusions Hemoglobin levels during pregnancy have significant effects on systolic and diastolic blood pressure in first, second and third trimsters of pregnancy. Regular measurement of hemoglobin levels during pregnancy can improve the health of pregnant women.

OBJECTIVETo provide basis for selecting the suitable method of Down's syndrome biochemical screening in the second trimester pregnancy.

METHODSA total of 30 547 singleton pregnancies between 14 and 20(+ 6) weeks of pregnancy were collected and analyzed for maternal serum alpha-fetoproteins (AFP) and human chorionic gonadotrophin, free beta subunit (beta-HCG) with or without unconjugated estriol (uE3). The screening risks were calculated using the software Lifecycle. The detection rates and the cost of per Down's syndrome detected were calculated and compared. And four different methods were compared in a series of 64 serum samples from Down's syndrome pregnancies.

RESULTS(1) Among the 64 affected cases, the detection rate of Down's syndrome was improved no matter in the double test (DT) or in the triple test (TT) if software Lifecycle (LC) was used to evaluate risks. And it was not suitable to evaluate risks with software 2T-Risks in the triple tests. (2) In the cohort of 30 547 singleton pregnancies, the detection rate of Down's syndrome with project DT-LC, which was double test using AFP and free beta-HCG together with software Lifecycle, and project TT-LC, which was triple test using AFP, free beta-HCG and uE3 together with software Lifecycle, was 56.25% and 57.14%, respectively. The former project was better because it decreased the false positive rate at a lower running cost.

CONCLUSIONThe DT-LC is an effective screening strategy for second trimester detection of fetal Down's syndrome in mainland China.

Adult ; Chorionic Gonadotropin, beta Subunit, Human ; blood ; Down Syndrome ; blood ; diagnosis ; Estriol ; blood ; Female ; Genetic Testing ; methods ; Humans ; Pregnancy ; Pregnancy Trimester, Second ; blood ; Prenatal Diagnosis ; economics ; methods ; Young Adult ; alpha-Fetoproteins ; metabolism

OBJECTIVETo review and summarize the early outcomes and clinical experience of coronary endarterectomy (CE) and bypass grafting without cardiopulmonary bypass for patients with diffused coronary artery disease.

METHODSFrom May 2003 to May 2005, 53 patients with diffused coronary artery disease underwent CE and bypass grafting without cardiopulmonary bypass. There were 41 males and 12 females aged from 55 to 79 (mean 64 +/- 7) years old. 72% patients (38/53) were in Canadian Cardiac Society (CCS) angina class III and IV. 49% (26/53) had history of myocardial infarction. Coronary angiogram revealed that 3 cases had double vessels disease and, other 50 cases had triple vessels disease with 9 left main stem disease. The left ventricular ejection fraction (LVEF) ranged from 0.26 to 0.65 (0.52 +/- 0.17). Seventy endarterectomies were performed in 53 patients totally which included 38 in left anterior descending artery (LAD), 8 in circumflex artery and 24 in right coronary artery. Five cases received on-lay venous patch after CE in LAD and then grafted by internal mammary artery (IMA) on the patch. There were 53 left IMAs, 2 radial arteries, others were great saphenous veins, the mean number of grafts was 3.8 +/- 1.1 with index of completeness of revascularization (ICR) 1.03 +/- 0.07.

RESULTSIntra-operative graft flow-meter was used to check the flow in the grafts before chest closure. There is no death in the group. Sixty-three (90%) out of 70 grafts after CE showed a satisfactory grafts flow intra-operatively. Two patients had peri-operative myocardial infarctions but neither had hemodynamic changes. All patients discharged uneventfully with mean hospital stay 9 days postoperatively. Forty-four patients had 6 to 29 months follow-up with no angina re-occurrence. Six patients had coronary angiogram 3 to 27 months postoperatively with all patent grafts to the CE coronaries.

CONCLUSIONCE and bypass grafting without cardiopulmonary bypass is technically feasible and can be performed safely in patients with diffused coronary artery disease with increased completeness of myocardial revascularization.

Aged ; Aged, 80 and over ; Atherectomy, Coronary ; methods ; Cardiopulmonary Bypass ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo analyze and assess the impact of clopidogrel given preoperatively in coronary artery bypass grafting (CABG) surgery.

METHODSFrom January 2005 to January 2007, 440 consecutive patients undergoing CABG surgery were divided into two groups: the clopidogrel group (with clopidogrel exposure in 5 days prior to surgery, n = 90) and the control group (without clopidogrel exposure > 5 days prior to surgery, n = 350). Patients undergoing emergency surgery because of failed percutaneous transluminal coronary angioplasty and cardiogenic shock, associated valvular surgery, redo-CABG were excluded. Patients who received aspirin and/or heparin treatment before surgery were included.

RESULTSThere was no significant difference in two groups regarding age, gender,diabetes mellitus and hypertension. Compared to the control group, patients in clopidogrel group had a higher prevalence of angina class III or IV (66.7% vs. 40.0%, P < 0.01), received more often revascularization within 48 h (41.1% vs. 14.3%, P = 0.02), and had received more frequently stenting (56.7% vs. 13.4%, P < 0.01). Chest tube drainage was significantly increased during the first 24 h following CABG in the clopidogrel group (800 ml vs. 350 ml, P < 0.01). Patients of the clopidogrel group also required more transfusion of packed red blood cells and fresh frozen plasma. Overall re-exploration rate because of bleeding was remarkably higher in the clopidogrel group (4.4% vs. 1.1%, P < 0.01).

CONCLUSIONSClopidogrel exposure in 5 days or less prior to CABG surgery significantly increases the risk of postoperative bleeding, the need for perioperative transfusion and the incidence of re-exploration. For the elective CABG patient, we suggest that the surgery should to be performed 5 days or more after clopidogrel exposure.

Aged ; Coronary Artery Bypass ; Female ; Humans ; Male ; Middle Aged ; Platelet Aggregation Inhibitors ; adverse effects ; Postoperative Hemorrhage ; chemically induced ; Preoperative Care ; Retrospective Studies ; Ticlopidine ; adverse effects ; analogs & derivatives ; Treatment Outcome