The purpose of this study was to investigate the different effects of ACh on the action potential and force contraction in guinea pig atrial and ventricular myocardium by using standard microelectrodes and force transducer. The results showed that the duration of the action potential (APD) of atrial myocardium was shortened from 208.57+/-36.05 to 101.78+/-14.41 ms (n=6, P<0.01), and the APD of the ventricular myocardium was shortened from 286.73+/-36.11 to 265.16+/-30.06 ms (n=6, P<0.01).The amplitude of the action potential (APA) of the atrial myocardium was decreased from 88.00+/-9.35 to 62.62+/-20.50 mV (n=6, P<0.01), while the APA of the ventricular myocardium did not change significantly.The force contraction of atrial myocardium was inhibited completely (n=6, P<0.01), while the force contraction of ventricular myocardium was inhibited by 37.57+/-2.58% (n=6, P<0.01). The ACh effects correlated with its concentration. The K(D) of the APD shortening effects in the atrial and ventricular myocardium were 0.275 and 0.575 micromol/L. The K(D) of the negative inotropic in the atrial and ventricular myocardium were 0.135 and 0.676 micromol/L, respectively. The corresponding data points were compared using t test between the atrial and ventricular myocardium, and the differences were significant when the ACh concentration was above 10 nmol/L. Furthermore, atropine (10 micromol/L) and CsCl (20 mmol/L) blocked the effects of 10 micromol/L ACh on the APD of ventricular myocardium, while CdCl2 (0.1 mmol/L) had no influence on these effects. In conclusion, ACh could shorten the action potential duration and inhibit the force contraction of atrial and ventricular myocardium in a concentration-dependent manner. There are differences in the effects of ACh on the atrial and ventricular myocardium. The atrial myocardium is more sensitive to ACh than the ventricular myocardium. It is probable that the muscarinic receptor and the potassium channel, but not the calcium channel, are involved in the ACh-induced shortening of the ventricular APD.
Acetylcholine ; pharmacology ; Action Potentials ; drug effects ; Animals ; Calcium Channels ; metabolism ; Guinea Pigs ; Heart Atria ; drug effects ; Heart Ventricles ; drug effects ; Microelectrodes ; Potassium Channels ; metabolism ; Receptors, Muscarinic ; metabolism

ObjectiveTo evaluate intraoperative cholangiography (IOC) and laparoscopic ultrasonography (LUS) for detection of occult common bile duct stones (CBDS) during laparoscopic cholecystectomy (LC). Methods From Jun. 2000 to Sep. 2001, 98 patients undergoing LUS and IOC during LC were analyzed prospectively.Results[The successful rate of LUS and IOC were 100% and 95% respectively, the time for LUS (7 7?2 1) min was significantly shorter than IOC (11 4?3 5) min ( P 0 05). The visualization of intrapancreatic portion of CBD by LUS was 62% vs 97% by IOC ( P

Objective To compare the safety and efficiency of laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) procedure for herniorrhaphy. Methods Between Jan 1997 and Jan 2005, 235 patients (274 hernias) underwent laparoscopic inguinal hernia repair with 163 TAPP in 139 patients and 111 TEP procedures in 96 patients. Postoperative patients were followed-up for 6-24 months. Results No conversion was necessary. There were no significant differences between TAPP and TEP when considering operating time, postoperative hospital stay, VAS and time to return to daily activity. The recurrence rate was 1. 8% and 0. 9% respectively in TAPP and TEP( P = 0. 524). The total incidence of postoperative complications were 15. 3% and 10. 8% respectively ( P = 0. 282 ) , with seroma, transient neurapraxia and urinary retention being 5. 5% vs. 4. 5% ( P = 0. 707 ) , 5. 5% vs. 3. 6% ( P = 0.464) and 3. 1% vs. 2.7%(P = 1.000). The inhospital cost was significantly higher in TAPP than in TEP(P=0.000). Conclusion TAPP and TEP are both safe and efficient tension-free technique. Surgeons' experience was more important than choice of approach to laparoscopic repair for groin hernias.

OBJECTIVETo comparatively study the effects of three TCM methods for activating blood circulation, i.e. in combined with resolving stasis (A), regulating qi (B) and supplementing qi (C), respectively, on early stage cell apoptosis in precancerous lesion of rats with chronic atrophic gastritis (CAG).

METHODSRat model of CAG with precancerous lesion was duplicated by insertion of spring in pylorus and gastric perfusion of high-salt hot paste; and the impact of treatment on cell apoptosis was determined using Annexin V/PI double labeled flow cytometry.

RESULTSAfter being intervened for 12 weeks, the early stage cell apoptosis rate in the natural recovery group was significantly higher than that in the control group (P <0.01); while it lowered more significantly in the three groups receiving TCM therapeutic methods for activating blood circulation, showing significant difference compared with the natural recovery group (P <0.01).

CONCLUSIONThree therapies of activating blood circulation all show inhibitory action on the early stage apoptosis of precancerous lesion in CAG rats, which is possibly one of their action mechanisms for improving or reversing the precancerous lesion.

Animals ; Apoptosis ; drug effects ; Blood Circulation ; drug effects ; Drugs, Chinese Herbal ; therapeutic use ; Gastritis, Atrophic ; complications ; Medicine, Chinese Traditional ; Precancerous Conditions ; complications ; drug therapy ; Qi ; Rats ; Treatment Outcome

Objective To investigate the traumatic characters, the causative factors and the outcomes of surgical treatments of cervical spinal cord injuries without radiographic abnormality(SCIWORA).Methods From March 2000 to July 2004, 81 patients of cervical SCIWORA undergone surgery were evaluated retrospectively. There were 55 males and 26 females, with a mean age of 57.3 years. According to the mechanisms of injuries and pathological changes of the cervical spine, the causative factors were divided into 3 groups: hyper-flexion type of injury (1 or 2 segments) with protrusion or prolapse of the cervical intervertebral discs (19 cases), hyper-extension type injury with multiple (≥3 segments) cervical spinal stenosis (41cases), and whiplash injury with multiple cervical spinal stenosis and segmental intervertebral instability or anterior protrusion of the cervical intervertebral discs (21 cases). A variety of surgeries as anterior discectomy with interbody fusion, multiple posterior decompressions with cervical laminoplasty, and multiple posterior decompressions with internal fixation at the facet joints were performed based the classification. Results The average follow-up period was 78.5 month (54-118 months). During the follow-up of 1 month, 3 months,1 year and last visit post-operatively, the rate of JOA improvement were 25.1%, 41.3%, 63.6% and 60.9%respectively. In the long-term follow-up, the good ratio of neurological function was obtained with 80.2%.Conclusion SCIWORA is considered as a course of acute, dynamic and limited injury. In spite of common clinical manifestation, its traumatic characters and causative factors are different indeed. The distinct improvement of neurological function can also be achieved with proper classification and surgery.

Objective To explore the safety and efficacy of policosanol in elder patients with high on-treatment platelet reactivity ( HPR) after drug-eluting stent ( DES) implantation. Methods This study was a prespecified subgroup analysis of the multicenter, randomized SPIRIT trial,in which there were a total of 169 elder patients (≥60 years old) with HPR. Among these patients, 30 patients were in group A ( given clopidogrel 75 mg/d for one year) , 75 patients in group B ( given clopidogrel 150 mg/d for 30 days followed by 75 mg/d until one year ) and 64 patients in group C ( given policosanol 40 mg/d for 6 month and clopidgrel 75 mg/d for one year ) . All patients were treated with aspirin at the same time. The primary endpoint was the reversion rate of HPR at 30 days (reversion was defined as platelet aggregation ﹤65%). The secondary endpoint was 2-year major adverse cardiac events ( MACE ) rate, which included cardiac death, non-fatal myocardial infarction and ischemic symptoms driven target vessel revascularization. The safety endpoint was any bleeding as defined by the Bleeding Academic Research Consortium ( BARC ) definition. Results At 30 days, the reversion rate of HPR in group C was numerically higher as compared with group A ( 42. 9% vs. 23. 3. 0%, P=0. 068 ) , and similar with group B ( 42. 9% vs. 49. 3%, P=0.447). MACE occurred in 4 (13.3%), 5(6.7%) and 3(4.7%) patients in group A, B and C respictively ( P=0. 352). Bleeding events in group A and group C were both markedly lower in comparison to group B (3. 3% vs. 17. 3% vs. 1. 6%, P=0. 001). At the 24-month follow-up, the MACE-free survival rates were not significantly different (95. 3% vs. 93. 3% vs. 86. 7%, P=0. 146). Conclusions For elder patients with HPR, policosanol reduced platelet reactivity to a similar extent in comparison of high maintenance dose of clopidogrel without increasing bleeding risk.

This commentary summarized the development trend of scientific research in the field of maternal and child health in China, based on the requirements of scientific innovation in the field of health care in China and the development goals of maternal and child health in the next ten years. Scientific research should be based on China's reality and solve China's problems; based on evidence-based evidence and promote its application and promotion; conduct interdisciplinary cooperation and promote the integrated development of disciplines; focus on academic frontiers and broaden international horizons.

Objective To evaluate the clinical characteristics of patients with growth-hormone adenoma (GHA) and summarize the diagnosis and treatment experience.Methods The clinical data of 338 GHA cases at the General Hospital of PLA from Jan. 1990 to Dec. 2016 were collected, of which 252 cases with more complete clinical data were retrospectively analyzed including their general situation, medical history, laboratory tests and auxiliary examinations, and treatment modalities and outcomes. Parts of the patients were followed up.Results The cases of hospitalized GHA patients have increased year by year since 1990, and the number of patients admitted in the last 3 years accounted for 56.2% of the total number of cases. The sex ratio for GHA patients was nearly 1:1. Age of visiting followed Gaussian distribution while the 41-50 age group occupied the largest part. The most typical sign is hand and foot enlargement (60.7%), followed by the hypertrophy of nasal ala. The most common symptoms are headache (42.5%), hypopsia, visual field defect and diplopia. More than half of GHA patients were complicated with prediabetes and diabetes (72.6%), sleep apnea (69.5%), goiter or thyroid nodularity (56.4%), cardiac insufficiency (57.0%) and colon polyp (54.1%); while the percentages of cases undergone the relevant examination in the total number of cases were as follows: 75g OGTT test (42.1%), polysomnography (23.4%), thyroid ultrasound (37.3%), echocardiogram (47.6%) and colonoscopy (14.7%); GHA was 23.37±1.42μg/L and IGF-1 was 804.28±273.93ng/ml on average; 85.0% of somatotroph tumors are macroadenoma. Surgery remains the mainstay of therapy to GHA, while medical therapy was selected by less patients. During the follow-up, only 38.0%of GHA patients can be contacted, among them the remission rate decreased to 40.5%. The positive rate of long-term remission evaluated by early postoperative GHA level was consistent with that confirmed by the long-term follow-up (χ2=3.368,P>0.05). Conclusions The number of hospitalized GHA patients have increased recent years. The common clinical signs and symptoms are somatic enlargement and nonspecific headache. Due to uncompleted screening, GHA associated complications are always misdiagnosed; It is essential to establish a sound model of follow-up to improve patients' quality of life. The early postoperative GHA levels may predict the prognosis of surgery.

Objective To evaluate the expression of vascular endothelial factor ( VEGF) -D in predicting the prognosis of colorectal carcinoma (CRC). Methods Between Jan 1996 and Jan 1998, 69 patients with CRC undergoing curative surgery were included in this study. Postoperative follow-up included physical examination, serum CEA, and imaging every 3 months in the first and the second year, every 6 months in the third year and once a year thereafter. The expression of VEGF-D protein and microvessel density ( MVD ) in 69 tissues of CRC and 20 normal colorectal tissues was examined by immunohistochemistry (IHC). Results of IHC staining were quantified by Axioplan 2 imaging analysis system. Results VEGF-D protein expression in the cytoplasm was found in all of the CRC tissues and 25% (5/20 ) of normal tissues. The VEGF-D expression was much higher in tumor tissue than in the corresponding normal tissue (P

OBJECTIVETo investigate the cause of hemorrhage from the gallbladder bed during laparoscopic cholecystectomy.

METHODSColor Doppler ultrasound was used to examine the cause of venous hemorrhage from the gallbladder bed during laparoscopic cholecystectomy in 1 patient postoperatively and to examine the anatomic relationship between the gallbladder bed and branches of the middle hepatic vein in 91 patients preoperatively.

RESULTSThere is a major branch of middle hepatic vein extended close to the gallbladder bed. The branch of the middle hepatic vein was completely adherent to the gallbladder bed in 14 of 91 patients (15.4%). The mean distance between the closest point of the middle hepatic vein and the gallbladder bed is 5.0 +/- 4.6 mm, the mean diameter of this point is 3.2 +/- 1.1 mm.

CONCLUSIONSPatients with large branches of the middle hepatic vein close to the gallbladder bed are at risk of hemorrhage during laparoscopic cholecystectomy and should be identified preoperatively with ultrasound.

Cholecystectomy, Laparoscopic ; adverse effects ; Female ; Hepatic Veins ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage ; etiology ; Risk Factors ; Ultrasonography, Doppler, Color