Objective To summarize the experience of 40 patients with carotid artery stenosis treated by carotid artery stenting (CAS). Methods Endovascular plasty and stent placement were performed in 40 patients with carotid artery stenosis from October 2000 to July 2002. A total of 43 stents were placed into, comprising 39 WALLSTENT stents and 4 SMART stents. Out of the 40 cases, cerebral protection devices were used in 5 cases. Results The stent placement was completed successively in all the patients.Diameters of carotid artery all returned to 4mm or above.Mild intraoperative ischemic stroke occurred in 2 cases, and severe intraoperative ischemic stroke was found in other 2 cases: visual field loss of the left eye in 1 case, with after-effects even 3 months after surgery; loss of consciousness and right hemiplegia in 1 case, whom was cured to full consciousness subsequently. The complication rate was 10% (4 of 40) and the rate of severe ischemic stroke was 5% (2 of 40). No complications were seen in patients with cerebral protection devices. Conclusions CAS is effective in the treatment of carotid artery stenosis. Carotid stenting with cerebral protection devices may further ensure the patients' safety.

Objective To explore the characteristics of clinic and epidemiology of neonatal respiratory syncytial virus(RSV) pneumonia in newborn infants.Methods Three hundred and nine neonates(male 196,female 113) who were admitted to children's hospital of Fudan University and identified as having RSV pneumonia from Jan.2004 to Dec.2008 were enrolled.RSV antigen was detected in exfoliated respiratory cells by direct immunofluorescence.All the clinical data were collected and subjects and they were divided into different groups based on path of infection,gestational age and RSV status.Results From case notes over the 5 years,309 eligible neonates with RSV infection were identified.Male term neonates were more likely to acquire infection,as compared to female,1.71.0.The incidence of RSV infection peaked in winter and spring.Compared with community acquired infection group,hospital acquired infection group had more premature infants(23.2% vs 8.7%,P=0.002),lower birth weight[(3 010.8?852.8) g vs(3 153.2?943.4) g,P=0.026],much longer mean length of hospital stay[(19.0?8.0) d vs(12.2?4.5) d,P=0],more expensive cost[(5 646.4?3632.2) RMB vs(4 175.8?2 879.2) RMB,P=0] and later occurrence day[(21.3?8.6) d vs(15.8?6.0) d,P=0].Compared with simple RSV infection group,mixed infection group had more expensive cost[(6 063.1?3 085.4) RMB vs(4 513.2?3 860.8) RMB,P=0.047] and more oxygen use(40.0% vs 25.7%,P=0.006).The clinical characteristics of patients with RSV pneumonia varied.Preterm group compared with term group more frequently exhibited apnea and cyanosis(20.0% vs 0.7%,42.9% vs 22.7%),respectively.Forty-two percent of them had bacterial infection,while 13.3% of them had infection of other part of body.The prognosis of most RSV(99.0%) infections was good.Conclusions RSV was an important cause of respiratory tract infections during the last five years.Clinical characteristics of RSV infections were atypical.Hospital acquired RSV infection was more severe than the community acquired infection in neonates.There are no specific,effective interventions for treating RSV infections,so preventive measures are most important.

Contents in orthopaedic are independent relatively and finding out the internal relations during them is helpful to improving the effect of orthopaedic teaching.Transfer theory is important tools for clinical teaching practice,and finding out the common characteristics between the orthopaedic chapters is primary for the theory.This research focuses on the following fields:fractures,nerve injury,infection,tumor and deformity.After the common characteristics between these chapters were analyzed and discussed,we concluded that the transfer theory is helpful in orthopaedic teaching practice,especially for students' comprehension and memory,but still we should avoid some negative effects in teaching process.

Objective:To study the direct medical expenses for inpatients with Multiple Myeloma and explore its influencing factors. Methods:A total of 1386 hospitalization records were collected using the reimbursement claim database in Guangzhou City during the period from January 2009 to December 2011 , which covered the entire enroll-ees of Urban Employee Basic Medical Insurance ( UEBMI) and Urban Resident Basic Medical Insurance ( URBMI) . Multivariate logarithmic regression models were used to analyze the influencing factors of direct hospitalization costs. Results:During the period from 2009 to 2011 , the total costs of inpatients with Multiple Myeloma were 19319 . 16 , 17364. 76 and 21427. 44 Yuan, and the individual out-of-pocket cash payments were 7049. 37, 5216. 5 and 6475. 39 Yuan respectively. The major influencing factors on direct medical costs of inpatients with the aforesaid disease were identified to be age, health insurance type, hospital level and length of hospitalization. Besides, the proportion of drug expenses as per average occupancy rate among UEBMI and URBMI cases during three years were 61. 92% and 69. 22% respectively. Conclusion: The direct medical costs for inpatients with Multiple Myeloma are high and the medicine cost is the main component of total medical expenses. In addition, the economic burden is higher for patients with URBMI than for those with UEBMI for treating Multiple Myeloma.

OBJECTIVEEndothelial apoptosis plays an important role in the initiation of atherosclerosis. It would be useful to clarify whether activation of non-neuronal muscarinic receptor (NNMR) could prevent endothelial apoptosis and atherosclerosis. We investigated the effects of NNMR activation on regulating rat aortic endothelial cells (RAECs) apoptosis induced by homocysteine, an independent risk factor of atherosclerosis, and further studied its molecular mechanism.

METHODSRAECs were incubated using homocysteine at the concentration of 2.7 mmol/L for 36 h. RAECs were also pre-treated with carbachol or arecoline to examine their effects. RT-PCR was used to assess changes in the gene expression related to cell apoptosis.

RESULTSIncubation of RAECs with homocysteine at the concentration of 2.7 mmol/L resulted in morphologic changes, such as cellular shrinkage, membrane blebbing, chromatin condensation and margination. These could be attenuated by pretreatment with carbachol and arecoline at the concentration of 10 micromol/L for 12 h. Homocysteine induced apoptosis in RAECs and the molecular mechanisms were associated with the regulation of fas, fas-L and caspase-8 in the death receptor pathway, bcl-2, bcl-xL and bax in the mitochondrial pathway, caspase-12 in the endoplasmic reticulum pathway and caspase-3, caspase-6 and p53 as downstream effectors. Carbachol and arecoline attenuated the effects of homocysteine on genes in the death receptor pathway, in the mitochondrial pathway and in the downstream pathway. Atropine could reverse all of the effects of arecoline.

CONCLUSIONActivation of NNMR by carbacol and arecoline inhibits homocysteine-induced endothelial cell apoptosis mainly through regulation of death receptor pathway, mitochondrial pathway and downstream effectors.

Animals ; Aorta ; cytology ; Apoptosis ; Apoptosis Regulatory Proteins ; metabolism ; Arecoline ; Carbachol ; Cell Cycle ; Endoplasmic Reticulum ; metabolism ; Endothelial Cells ; cytology ; drug effects ; Homocysteine ; adverse effects ; Mitochondria ; metabolism ; Rats ; Receptors, Muscarinic ; metabolism

Objective To investigate whether tolterodine combined with pelvic floor electrical stimulation is more effective than tolterodine alone in the treatment of wonen with overactive bladder(OAB) and the underlying mechanism.Methods Seventy-three female patients with OAB were recruited from our hospital during Oct.2009 to Dec.2010 and prospectively studied,of whom 39 cases were given tolterodine(2 mg each time,twice daily for4 weeks)alone while the other 34 cases were given tolterodine combined with pelvic floor electrical stimulation for the treatment of OAB.Data on urgency,incontinence,micturition frequency,nocturia episodes and voided volume were collected before and after 4 weeks' treatment using a week micturition diary.Results The differences of changes of OAB symptoms between the 2 groups had statistical significance (P ＜ 0.05).Patients in the tolterodine combined with pelvic floor electrical stimulation group reported treatment benefit than the tolterodine group in the micturitions and the volume voided per micturition(P ＜ 0.05).There were no difference in the number of urgency episodes per 24 hours,incontinence episodes and nocturnal episodes (P ＞ 0.05).Conclusion A combination of toterodine with pelvic floor electrical stimulation could significantly improve the OAB symptoms,and is a potential therapy for female patients with OAB.

Objective: To study the quality and transdermal properties of matrine microemulsion-based hydrogel (MBH) to provide basis for the development of the preparation.Methods: The stability of MBH was observed at 4 ℃ for 3 months and the changes of particle appearance, viscosity, pH and matrine content were observed.The transdermal permeation of MBH was investigated by a dual chamber permeation and diffusion device with excised mouse skin as the barrier.Taking rabbits as the experimental subjects, the irritation of MBH to the normal skin and damaged skin was investigated.Results: The appearance, viscosity, pH and matrine content of MBH at 4 ℃ in 3 months did not change significantly.In vitro transdermal test showed that MBH had a good penetration rate on mouse skin, and no skin irritation occurred after single or multiple administrations.Conclusion: MBH has good stability and high rate of transdermal penetration without skin irritation, which is a promising drug delivery system of matrine with good application prospects.

Objective To observe the clinical efficacy of the TESSYS (transforaminal endoscopic spine system) technique of percutaneous transforaminal endoscopic discectomy combined with oral use of Chinese medicine for the treatment of lumbar disc herniation.Methods Thirty-nine patients with lumbar disc herniation were treated by the TESSYS technique of percutaneous transforaminal endoscopic discectomy,and then received oral use of modified herbal medicine Xubi Recipe,a formula mainly having the actions of tonifying kidney and strengthening governor vessel for 4 weeks after the operation.The visual analogue scale (VAS) and Oswestry disability index (ODI) and modified MacNab criteria were employed to assessed the surgical outcomes before the operation,and 3 and 6 months after the operation.Results (1) All of the 39 cases completed the operation successfully,and were followed up for 6-12 months after the operation.(2) Three and 6 months after the operation,the VAS scores and ODI scores were obviously lower than those before the operation,and the differences were significant (P ＜ 0.05).(3) Six months after the operation,the excellent rate of clinical efficacy assessed by modified MacNab criteria was 89.74％.(4) Only 4 cases had severer transient pain and numbness in the affected limbs,and there was no occurrence of complications of permanent neural root trauma,dural tear,vascular injury,intestinal damage,spondylodiscitis or retroperitoneal hematoma.Conclusion The TESSYS technique of percutaneous transforaminal endoscopic discectomy combined with oral use of Chinese medicine is effective for the treatment of the lumbar disc herniation with the advantages of satisfactory short-term effect,less bleeding,less trauma,faster recovery and less complications.

Objective To analyze the correlation between functional single nucleotide polymorphisms (SNPs)in TYMS gene and the prognosis of hepatocellular carcinoma (HCC)patients treated with transcatheter arterial chemoembolization (TACE).Methods Five functional SNPs in TYMS gene were genotyped in a cohort of 41 9 unresectable Chinese HCC patients treated with TACE and prognosis analysis was performed.Results No SNP significantly associated with OS of HCC,but in patients with only TACE treat-ment,SNPs rs523230 exhibited significant associations with death risk in HCC patients under the additive model.Patients over 60 years old,SNP rs9967368 exhibited significant associations with death risk in HCC patients under the recessive model.Conclusion Genetic variations in TYMS gene may be a potential biomarker for predicting clinical outcome of HCC patients treated with TACE.