To search the statistical approaches for evaluating and dealing with the center effects in multi-center clinical trial. Breslow-Day test was used for evaluating the differences of the virtual rating among the centers whose responses were binary, Cochran-Mantel-Haenszel test for dealing with the center effects whose responses were binary or ordinal, and logistic regression for evaluating and dealing with the center effects simultaneously. The results showed that Breslow-Day test is invalid in evaluating the center effects whose response is ordinal, and Cochran-Mantel- Haenszel test can not be used for dealing with the effects of other covariates meanwhile.

Objective To discuss the clinical application and features of coronary artery bypass grafting(CABG) through left intercostal thoracotomy approach. Methods A total of 36 cases of CABG were performed through left intercostal thoracotomy approach from September 1996 to August 2005 in this hospital.The patients fell into four categories: ①single vessel disease in the left anterior descending artery(LAD);②re-operation of CABG with a patent LIMA(left internal mammary artery)-LAD bypass;③severe calcified ascending aorta;and ④concurrent other procedures that required left thoracotomy.There were 26 cases of single vessel disease,3 cases of double vessel disease,and 7 cases of triple vessel disease.Five cases had a history of percutaneous coronary interventions(PCIs) and 6 cases had a history of CABGs.The left ventricular ejection fraction was 0.562?0.107. Results Off pump CABG with 1~4 distal anastomosis was successfully accomplished in all the 36 cases,with an operation time of 190.4?44.1 min.Concurrent procedures included 2 cases of transmyocardial laser revascularization(TMLR),1 case of lung cancer resection,and 1 case of esophageal cancer resection.There was no in-hospital mortality.Two fatal cases were seen in long-term follow-up observations.Recurrent angina developed in 2 cases 1 year after operation,and was cured with a PCI in 1 case and with a re-operation of CABG in 1 case. Conclusions The left intercostal thoracotomy is a safe and feasible approach for CABG surgery in patients with some special types of coronary heart disease.The procedure can be performed under beating heart.

Objective To report the experience of first 100 cases of off-pump coronary artery bypass(OPCAB) grafting by a training cardiac surgeon,and to discuss the feasibility of the training method.Methods The trainee,who had no previous experience of coronary surgery,received an OPCAB training program under the guidance by a director who had completed more than 2000 cases OPCAB.After 28 months of training,the trainee began to be an independent operator.The data of the first consecutive 100 cases of OPCAB by the trainee(Training Group) were collected for comparison with the director's 100 cases of OPCAB surgery(Control Group).Results There were 5 cases of conversion to on-pump surgery in the Training Group.The number of distal anastmosis in the Training Group(2.9?0.6) was smaller than that in the Control Group(3.5?0.7)(t=-6.508,P=0.001).Compared with the Control Group,there were less circumflex grafts(67/100 vs 88/100;?~2=12.645,P=0.000) and sequential grafts(3/100 vs 27/100;?~2=22.588,P=0.000) in the Training Group.There was no significant difference in mortality between the Training Group(3%,3 cases) and the Control Group(1%,1 case)(?~2=0.255,P=0.614).No significant difference was observed between the two groups in other postoperative severe complications.Conclusions The first 100 cases of OPCAB surgery performed by the trainee give favorable results,indicating a stable transition from training period to independent performance.It also testifies the feasibility of this training program.

Atherosclerosis ; complications ; pathology ; Humans ; Thrombosis ; complications ; pathology

Adult ; Antiretroviral Therapy, Highly Active ; Female ; HIV Infections ; drug therapy ; Humans ; Lamivudine ; administration & dosage ; Male ; Middle Aged ; Treatment Outcome ; Zidovudine ; administration & dosage

Objective To analyze the clinical treatment in patients with nevus of Ota with Q switched Nd∶YAG Laser. Methods Total 326 patients nevus of Ota were treated. According to the shade of pigment, age and gender of the patients, the different technical parameters were selected. Results After 2 4 times of treatment, excellent results were obtained in 221 patients, good in 74 patients, and improved in 31 patinets. The total effective rate was 90.5 %. After treatment, the skin exposured to the laser in the patients had reaction of continued pigmentation in different degree. Usually, the above reaction will gradually disappeared without any scar formation. Conclusion Satisfactory results are obtained in patients with nevus of Ota treated with Q switched Nd∶YAG laser. [

Objective To investigate the expression of osteopontin(OPN) mRNA and its correlation with clinicopathologic features of glioma. Methods The expression of OPN mRNA was detected by semi-quantitive RT-PCR in 60 cases of gliomas and their correspondent normal tissues.The relationship between the relative content of OPN mRNA and clinicopathologic features of glioma was also analyzed. Results The positive rate of OPN mRNA expression was 73.3%(44/60) in our group.The OPN mRNA expression in normal brain tissue was all negative.Furthermore,the OPN mRNA expression was associated with the pathological grade of glioma.All patients were followed up for an average of 12 months.We did observed that the OPN mRNA expression positive group(44 cases) had recurrence in 36 patients and the negative group(16 cases) had only 2 case with recurrence (P

Objective: To summarize and analyze the early outcomes and clinical experience in 1198 patients undergone off-pump coronary artery bypass (OPCAB). Methods: This multi-center report covers 15 different institutes in China from October 1996 to May 2002. The ratio of OPCAB to conventional coronary artery bypass grafting (cCABG) was 85.2%. The mean age was (61.6?9.0) years. 77.3% patients were male and 22.7% were female. There were 34.6% patients with myocardial infarction, 58.2% with unstable angina pectoris, 18.7% with left main lesion, 76.9% with triple-vessel disease, 1.5% was redo surgery, and 9.9% emergent or urgent surgery. The mean left ventricular ejection fraction was 0.56?0.17. Results: The number of distal anastomosis was 3.1?0.9. IMA was used in 65.6% patients and radial artery was used in 18.0%. 13.5% OPCAB was combined with TMLR. IABP was used in 5.2% patients. The hospital mortality was 1.2%. The morbidity included 0.4% peri-operative myocardial infarction, 0.3% heart failure, 1.2% fatal arrhythmia, 2.0% pulmonary complications, 1.2% neurotic disorder, 0.7% renal dysfunction, 1.0% reopen for bleeding, and 0.6% delayed wound healing. Conclusion: OPCAB surgery is a safe and feasible procedure with good early results. Its late outcomes need further follow-up. OPCAB requires certain special skills and methods in practice so a specific training course should be designed.

Objective: To investigate the risk factors for mortality in neonates with congenital esophageal atresia (CEA) and simple congenital heart disease (CHD) including atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). Methods The medical records of neonates with CEA and simple CHD who had surgery in Children’s Hospital of Chongqing Medical University from 1998 to 2013, were analyzed retrospectively. Factors including neonatal demographics, laboratory results and complications after surgery were compared between survivor and non-survivor groups. Results Seventy ifve cases were included in this study and the mortality was 10.67%(8/75). There was no signiifcant difference between non-survivor group (n=8) and survivor group (n=67) in factors such as gestational age, birth weight, age of admission, age at surgery, duration of surgery, full blood examination, serum electrolytes, blood gases, prevalence of septicemia, pneumothorax, and cold lesion syndrome. However, the prevalence of respiratory failure and heart failure in non-survivor group was higher than that in survivor group (75%vs. 9%, P=0.000;50%vs. 1.5%, P=0.000, respectively). Conclusions The poor outcome among neonates with CEA plus simple CHD might be associated with respiratory failure and heart failure.

Objective To explore the expression of discoidin domain receptor 1 (DDR1) in rats with pulmonary fibrosis induced by paraquat (PQ) poisoning, and its relationship with the expression of transforming growth factor-β1 (TGF-β1). Methods 120 Sprague-Dawley (SD) rats were divided into control group and 20, 40, and 80 mg/kg PQ poisoning groups (each n = 30). Pulmonary fibrosis induced by PQ poisoning model was reproduced by one time administration of 20, 40, 80 mg/kg of 20% PQ, and the rats in control group were given 4 mL normal saline. Fifteen rats in control and different doses of PQ groups were sacrificed at 7 days and 21 days after intragastric administration, and lung tissues were collected. Pulmonary fibrosis was observed after hematoxylin-eosin (HE) staining. The immune-histochemical method was used to determine the expressions of DDR1 and TGF-β1. The relationship between the expression of TGF-β1 and DDR1 was analyzed by Pearson correlation analysis. Results The rats in control group were active, and no pathological changes in lung tissue were found. The rats in PQ groups became shortness of breath, bristles, and slow reaction etc. 0.5 hours after intragastric administration. After 7 days, the lung tissue was dark red, hard texture, appearance of yellow soil fiber nodules and obsolete hemorrhage, destruction of alveolar structure. The extent of lung injury increased gradually with the time of poisoning and the increase of PQ dose. It was shown by immune-histochemical staining that the control group had only a small amount of DDR1 and TGF-β1 positive expressions; in PQ groups, there were a large number of DDR1 and TGF-β1 positive expression particles in the alveolar wall, pulmonary interstitial and alveolar cavity. It was displayed by quantitative analysis that compared with the control group, DDR1 and TGF-β1 expressions were significantly increased in 20, 40, 80 mg/kg PQ groups with time- and dose-dependent [DDR1 (integral A value): 0.221±0.014, 0.249±0.021, 0.364±0.016 vs. 0.121±0.036 at 7 days; 0.247±0.025, 0.321±0.015, 0.432±0.027 vs. 0.139±0.021 at 21 days; TGF-β1 (integral A value): 0.230±0.016, 0.265±0.015, 0.339±0.016 vs. 0.129±0.032 at 7 days; 0.248±0.011, 0.295±0.016, 0.399±0.026 vs. 0.119±0.026 at 21 days; all P < 0.05]. It was shown by Pearson correlation analysis that DDR1 expression was positively correlated with TGF-β1 expression with the increase of PQ dose and poisoning time (DDR1 with TGF-β1: r = 0.996, P < 0.000; DDR1 with PQ dose: r = 0.985, P < 0.000; DDR1 with poisoning time: r = 0.989, P < 0.000; TGF-β1 with PQ dose: r = 0.992, P < 0.000; TGF-β1 with poisoning time: r = 0.972, P < 0.000). Conclusions The expression of DDR1 in the lung tissue in PQ poisoning rats showed a time- and dose-dependent change, and it was positively correlated with TGF-β1 expression. DDR1 may be involved in the process of pulmonary fibrosis induced by PQ poisoning.