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.

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

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 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 compare the relief effect of diltiazem, papaverine and nitroglycerin on radial artery spasm in elderly patients with coronary atherosclerotic heart disease.

METHODSSixty patients aged beyond 70 years underwent coronary artery bypass grafting (CABG) with autologous radial artery from July 2009 to March 2010. Redundant radial artery was collected and the relief function of different drugs was evaluated through "organ bath" technique in vitro. All the patients were randomly divided into 3 groups based on different antispasmodic drugs: diltiazem, papaverine and nitroglycerin. Thirty seconds free blood flow of radial artery and hemodynamic parameters (heart rate, mean arterial pressure and central venous pressure) were assessed before and after intra-radial administration of diltiazem, papaverine and nitroglycerin in vivo.

RESULTSAll three drugs could relieve radial artery spasm in different levels and the eventual relief rate was over 80%. Only nitroglycerin could relax radial artery completely, the relief capacity of nitroglycerin, diltiazem and papaverine decreased in order. There was no significant difference in the hemodynamic parameters before and after the injection. Blood flow of radial artery increased in nitroglycerin group [(42 ± 10) ml/30 s vs. (28 ± 7) ml/30 s, P < 0.05] while there was no significant difference in diltiazem [(23 ± 10) ml/30 s vs. (25 ± 8) ml/30 s, P > 0.05] and papaverine group [(25 ± 10) ml/30 s vs. (24 ± 9), P > 0.05].

CONCLUSIONSNitroglycerin could relieve vasospasm of radial artery effectively and increased blood flow. Nitroglycerin is the suitable antispasmodic drug for radial artery in the elderly patients with coronary atherosclerotic heart disease compare with diltiazem and papaverine.

Aged ; Aged, 80 and over ; Coronary Artery Bypass ; Coronary Artery Disease ; physiopathology ; surgery ; Diltiazem ; pharmacology ; Female ; Follow-Up Studies ; Humans ; Male ; Nitroglycerin ; pharmacology ; Papaverine ; pharmacology ; Parasympatholytics ; pharmacology ; Radial Artery ; drug effects ; physiology ; transplantation

OBJECTIVETo establish the median of serum markers for second trimester screening in Qingdao region and to assess the influence of median correction on the performance of screening.

METHODSMaternal serum alpha-fetoproteins (AFP), human chorionic gonadotrophin, free beta subunit (β -HCG) and unconjugated oestriol (uE3) were assayed for prenatal screening of 18 188 singleton pregnancies at 15-20(+ 6) weeks gestation from January 2009 to July 2010. The median of serum markers was calculated based on above results and applied for risk estimation in screening for fetal aneuploidy from August 2010 to March 2011. The screening performance, specified in terms of detection rates (DRs), false positive rates (FPRs) and odds of being affected given a positive result (OAPR) were compared between the two groups. The risks of 45 affected pregnancies detected during the study were estimated with both Caucasian and corrected medians.

RESULTSThe average level of AFP in local pregnancies was similar to that of the Caucasian population, whilst β -HCG and uE3 were respectively 11% and 33% higher than those of Caucasians. The multiple of median (MoM) value was between 0.94 and 1.02 for the dataset based on the corrected median. At a cut-off of l in 270, FPR has decreased from 5.2% to 4.9%, and DR of Down syndrome has increased from 60% to 69.2%, and OAPR has increased from 1:79 to 1:59 when evaluating risk based on the corrected median. For the 45 affected pregnancies, three Down syndrome pregnancies could be missed because their risk estimates were lower than the cut-off level based on Caucasian median.

CONCLUSIONIt is useful to establish and apply population and laboratory-specific medians in order to improve the performance of prenatal screening and diagnosis.

Adult ; Biomarkers ; blood ; Estriol ; blood ; Female ; Humans ; Lindane ; blood ; Pregnancy ; Pregnancy Trimester, Second ; Prenatal Diagnosis ; methods ; alpha-Fetoproteins ; analysis

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