Objective To explore the effect of trimetazidine, telmisartan and low molecular weight heparin (LMWH) on improving cardiopulmonary function, hemorheology and clinical symptom of chronic pulmonary heart disease in acute exacerbation. Methods A total of 96 patients with chronic pulmonary heart disease in acute exacerbation were randomly divided into group A (40 cases) and group B (56 cases ).The group A was treated with general method and the group B was treated with trimetazidine, telmisartan and LMWH besides general method. After 3 weeks' treatment, ca_rdiopulmonary functional parameters,hemorbeology parameters and clinical symptoms were observed. Results After treatment, the left ventricular ejection fraction (LVEF), and the ratio of forced expiratory volume in one second and forced vital capacity (FEV_1/FVC ) improved in group B (P<0.05 ), and there were significant difference in LVEF, FEV_1/FVC after treatment between two groups (P<0.05). The clinical total effective rate in group B (92.9%, 52/56 ) was significantly higher than that in group A (67.5%, 27/40 ) ( P<0.05 ). Conclusion Trimetazidine, telmisartan and LMWH is effective to improve patients' cardiopulmonary function, hemorheology parameters and clinical symptoms in the treatment of chronic pulmonary heart disease in acute exacerbation.

ObjectiveTo discuss the effect of surgical treatment of varicose vein on primary chronic venous insufficiency(PCVI) in the lower extremities.MethodsBetween August 2007 and August 2008,128PCVIpatients underwenthighligationof the greatsaphenousveinandendovenous electrocoagulation of the varix superficial vein. Spectrum Doppler ultrasound was used to measure the superficial femoral vein blood flow hemodynamic information beneath the first pair of valve including quiet breathing condition and the Valsalva action (reflux time、caliber、reflux velocity). Reflux index (RI) was used as guide line.ResultsClinical sympotoms improved in 54 out of 60 mild PCVI cases, in 29 of 45 moderate PCVI patients, while only in 6 out 23 cases in whom severe preoperative clinical symptom with PCVI was present.The effective rate respectively was 90％, 64％, and 30％.The mild reflux index significantly improved than that before operation ( t = 21. 484, P = 0. 000 ), the moderate reflux index improved than that before operation ( t = 2. 173, P = 0. 035 ), while the serious reflux index were not statistically improved than that before operation( t = 1. 888, P = 0. 078 ). In all cases reflux index improved after the surgery ( x2 = 8. 266,P = 0. 004).ConclusionsMinimally invasive surgical treatment of varicose veins can improve the reflux of the deep vein in PCVI cases with mild to moderate clinical symptom.

Objective To explore the expression of tyrosine phosphatase containing c-Src homology SH2 (SHP-2) in condyloma acuminatum. Methods Phosphorylated tyrosine and SHP-2 were detected in skin lesions of 30 patients with condyloma acuminatum, tumor tissues of 13 cases of cervical cancer and normal foreskin tissues of 11 normal controls by SP immunohistochemical stain. Results In the foreskin tissue, the phosphorylated tyrosine and SHP-2 were mainly expressed on the nuclei of kerotinocytes adjacent to the basal layer, and the number of cells with positive expression was not so many. In condyloma acuminatum, the positive cells arranged in patches, phosphorylated tyrosine and SHP-2 distributed in the cytoplasm. In cervical cancer, the expression of phosphorylated tyrosine and SHP-2 were mainly in the cytoplasm, diffusely distributed, and not in the nuclei. The positive expression rates of phosphorylated tyrosine and SHP-2 in condyloma acuminatum and cervical cancer were 96.67% (29/30) and 100% (13/13), respectively. However the cytoplasm of normal foreskin showed negative expression(0/11). Conclusions There is an aberrant activation of phosphorylated tyrosine and SHP-2 in condyloma acuminatum and cervical cancer. SHP-2 may play an important role in the carcinogenesis.

Objective To identify the hemolysin BL(HBL) gene from Bacillus cereus of patients with endophthalmitis comfirmed by API bacterial identification test strip,and detect its biological activity in vitro.Methods Three pairs of specific primers were designed according to the gene sequence of HBL(B,L1 and L2 components),then the PCR assay were established through condition optimization,and to further detect five Bacillus cereus strains isolated from clinical patients with endophthalmitis.HBL with biological activity was extracted by salt fractionation from a randomly selected strain,and a series of different concentrations of HBL were prepared and acted on sheep red blood cells(SRBC),Vero cells and Hela cells; virulence of HBL was also assessed through observating lethal effect of which on mice with intraperitoneal injection.Results Three genes of HBL were detected in all B.cereus strains from clinical patients; Strong hemolytic activity of HBL showed obvious time-and dose-dependent.In the study,we found the morphological changes of Vero and Hela cells caused by HBL were different,but cell death were the same result with contents released; Within 48 h after infection,lethality of HBL for mice showed 100％ with the concentration of more than 2.0 HU/ml,and was also in a time-and dose-dependent manner.Conclusion HBL isolated from B.Cereus had high hemolysis activity and low concentration.The expression of all BL genes provided a strong basis for the clinical feature of B.Cereus infection,which was developed rapidly and with a poor prognosis.It also provided a new method for rapid diagnosis and molecular epidemiology investigation in clinical.

BACKGROUND:For patients with rheumatoid arthritis and Kümmel ’s disease, how to effectively control back pain, to recover patient’s locomotor activity and to avoid a vicious cycle of disuse osteoporosis is a key therapeutic target. Kyphoplasty is a recently developed new technology of minimal y invasive spine surgery. Few reports concerned the kyphoplasty for rheumatoid arthritis and Kümmel ’s disease. OBJECTIVE:To assess the clinical outcome of bone cement kyphoplasty for the treatment of Kümmel ’s disease combined with rheumatoid arthritis. METHODS:From June 2012 to July 2013, 11 female patients at the age of 65.4±5.1 years with Kümmel ’s disease combined with rheumatoid arthritis, who suffered from severe back pain, were treated with bone cement vertebroplasty. Back pain and imaging indexes were compared and observed before surgery and during fol ow-up. Imaging indexes contained preoperative and postoperative anterior height of vertebral body after fractures, the ratio of anterior height to posterior height of the vertebral body, and local kyphosis angle (Cobb method). RESULTS AND CONCLUSION:No patients were lost to fol ow up. 11 patients were fol owed up for 6 to 12 months. Significant differences in fol ow-up and preoperative Visual Analogue Scale scores, anterior height of vertebral body after fractures, the ratio of anterior height to posterior height of the vertebral body, and local kyphosis angle were detected (P<0.05). Two patients experienced bone cement leakage. No severe complications appeared such as pulmonary embolism or neurological dysfunction. These data confirmed that bone cement vertebroplasty for rheumatoid arthritis combined with Kümmel ’s disease can effectively lessen back pain, partial y restore the height of vertebral body after fracture, rebuild spinal stabilization, reduce local kyphosis, and is a safe effective repair method.

Objective To explore the role of the DACT2 gene in the occurrence and development of renal cell carcinoma(RCC).Methods The samples of RCC tissues and corresponding tumor-adjacent tissues after radical operation and normal kidney tissues were collected.The methylation specific PCR (MSP) and real time fluorescence reverse transcriptase-PCR (RT-PCR) methods were adopted to detect the methylation status and mRNA expression of DACT2.The streptavidin-peroxidase (SP) method labeled by immunohistochemistry peroxidase was used to examine the expression of β-catenin protein.Then the relationship between DACT2 gene methylation status and mRNA expression with the clinicopathologic characteristics was analyzed.The relationship between DACT2 gene methylation with mRNA and β-catenin expression was analysed,as well.Results The DACT2 mRNA relative expression level in RCC tissues was 0.427±0.025,which was significantly lower than (0.801±0.047) in tumor-adjacent tissues and (0.872±0.022) in normal tissue,the positive rate of DACT2 gene methylation in RCC tissues was 45.76%,which was significantly higher than 6.78% in tumor-adjacent tissues and 5.08% in normal tissues,the difference was statistically significant (P<0.05),while the difference between tumor-adjacent tissues and normal tissues had no statistical significance (P>0.05).The DACT2 gene mRNA expression level in RCC tissues and promoter area methylation occurrence rate had no obvious correlation with the clinical data such as patients age,gender,tumor size,clinical stage and Fuhrman grade (P>0.05).The DACT2 gene mRNA relative level in the methylation group was lower than that in the non-methylation group,the difference was statistically significant (P<0.05).The expression rate of β-catenin protein in cytoplasma in RCC tissues was higher than that in the tumor-adjacent tissues and normal tissues,the difference was statistically significant (P<0.05),moreover,DACT2 gen methylation had a positive correlation with β-catenin protein expression (r=0.324,P=0.012).Conclusion The decrease of DACT2 gene promoter area methylation and mRNA relative expression level may participate in the RCC occurrence,but has no relationship with RCC clinical progression.Methylation occurred in DACT2 gene promoter area may be one of reasons causing mRNA relative expression decrase.DACT2 gene methylation occurrence in RCC tissue might be related to the high expression of β-catenin.

BACKGROUND:In recent years, vacuum sealing drainage technology has been widely used in the treatment of orthopedic wounds or to facilitate skin graft survival, both of which have achieved good results.
OBJECTIVE:To observe the curative effects of vacuum sealing drainage technology in the wound healing after limb open fractures, soft tissue defects, pressure sores, and chronic osteomyelitis.
METHODS:Fifty-four patients of fractures combined with soft tissue defects, postoperative exposed bone, osteomyelitis, a large area of pressure ulcers or severe infections, selected from the 273rd Hospital of PLA, were randomly divided into test and control groups according to the wishes of patients. The test group included 36 patients who were treated with vacuum sealing drainage using polyethylene ethanol hydration seaweed salt after debridement, and the control group included 18 patients who were treated with conventional dressing. Wound cleaning time, number of dressings, and wound healing time were detected and compared in the two groups.
RESULTS AND CONCLUSION:Compared with the control group, the wound cleaning time and wound healing time were shorter in the test group, and the number of dressings was also decreased in the test group (P<0.05). After removal of sponge dressings, in the test group, wound granulation was fresh and grew obviously with no exudates after the necrotic residue was removed and vacuum sealing drainage was changed. For the bone exposure patients, the wound area was reduced, or even there was no exposed bone any more. After skin grafting, vacuum suction and pressure due to vacuum sealing drainage technology made al skin grafts survive. In the patients with chronic osteomyelitis, the exudates were gradual y reduced until disappeared after vacuum sealing drainage was exchanged three or four times, and pathogens were not found in bacterial culture. After combined treatment of debridement and vacuum sealing drainage, there were many fresh granulations in the patients with large areas of pressure sores;after replacement of vacuum sealing drainage several times, the granulation grew to the same height with the surrounding skin.

Objective To establish a Chinese expert consensus of the surgical management for type A aortic dissection (TAAD) by using the Delphi method.Methods A systematic review of the previously published literature related to management of TAAD at home and abroad was conducted to formulate a questionnaire of clinical consensus of the surgical treatment for TAAD.This questionnaire including seven aspects of surgical management for TAAD,namely contraindications to operative management,cannulation site,target temperature during circulation arrest,cerebral perfusion strategy,surgical procedure,distal anastomotic technique and surgical management for patients with connective tissue disease such as Marfan syndrome.From October 2015 to April 2016,we performed two rounds Delphi survey in which the current professional opinions from 55 experienced and representative cardiovascular surgeons in China,were gathered and analysed.Results The responses rates of two rounds were 80.0％ (44/55) and 77.27％ (34/44).The scores of authoritative coefficient was 0.87 and 0.83.The coefficient of concordance were 0.31 (P ＜ 0.05) and 0.32 (P ＜ 0.05).After two rounds of consultation,consensus of the surgical management for TAAD was reached on 16 items of seven aspects.Conclusion This Delphi study established an initial Chinese expert consensus concerning the surgical management for TAAD,which drew credible results and reliable conclusions.This study will helo to standardize the surgical management of TAAD in China.

Objective To estimate the incidence of drop out of treatment in patients with access to methadone maintenance treatment and explore the correlation and interaction between insufficient methadone dosage and morphine positive urine on the drop out in Guangxi Zhuang Autonomous Region.Methods Face to face interview was conducted in 1 031 patients at 3 methadone maintenance treatment clinics in Guangxi.Results The study included 1 031 participants,40.6％ of them (419/1 031) had stopped treatment.The drop out rates in urine morphine positive group and methadone dosage ＜ 100 mg/d group were 57.6％ (99/172) and 37.4％ (347/929) respectively,higher than those in urine morphine negative group and methadone dosage ≥ 100 mg/d group (42.3％,363/ 859,and 26.5％,27/102).Orderly logistic regression analysis results showed that after adjusted factors,such as gender,age,marital status,ethnic group,patients who received a dosage less than 1 00 mg/day (OR=3.05,95％CI:1.84-5.06) and had morphine positive urine (OR=2.25,95％CI:1.59-3.19) were more likely to drop out of the treatment.Interaction analysis showed that dosage less than 100 mg/d and morphine positive urine during treatment had additive interaction (RERI=256.46,AP=0.87,S=8.05) and multiplication interaction (OR=2.45,95％CI:1.71-3.49).Conclusion Insufficient dosage and morphine positive urine were significantly correlated with drop out of treatment in patients with access to methadone maintenance treatment.

Objective To reveal the prevalence and the related factors of hepatitis B (HepB) virus infection among HIV/AIDS patients.Methods We conducted a cross-sectional study in two HIV clinics,affiliated to local Centers of Disease Control and Prevention in Guangxi Zhuang Autonomous Regional.A face-to-face interview,with questionnaire was conducted to collect information on socio-demographic characteristics,drug use,and sexual behavior.Blood samples were used to test HBsAg.x2 test or Fisher's exact test and unconditional logistic regression models were used to identify the influencing factors.Results The prevalence of HBV and HIV co-infection was 13.85％ (113/816).Results from multivariate logistic regression analyses showed that age (25-45),family history of HBV and history of HepB vaccination were independent influencing factors for HBV and HIV coinfection,with OR (95％ CI) as 1.738 (1.031-2.931),2.898 (1.678-5.005) and 1.744 (1.052-2.892),respectively.Conclusion The prevalence of HBV among HIV/AIDS patients was significantly higher than that in general population.HIV/AIDS patients aged between 25 and 45 and with family history of HBV were more likely to be infected with HBV,while HepB vaccination was associated with the reduction of HIV/HBV coinfection.Specific comprehensive prevention and treatment programs on HIV/AIDS patients need to be set up.