Objective To study the clinical characteristics of the surgical treatment of cardiac valve disease in elderly patients.Methods Between January 2004 and February 2009,43 patients aged ≥65 underwent cardiac valve operation were enrolled as elderly group,85 patients aged <65 underwent the same operation served as control group in the same period,analyzed the clinical characteristics and difference between the two groups.Results The mortality of elderly group was higher than that of control group [11.6%(5/43) vs 2.4% (2/85),P<0.05].In elderly group,the duration of staying in ICU [(73.8±15.9) h],mechanical ventilation [(40.4±10.1)h],postoperative hospitalization time [(23.7±6.3) d]and the morbidity of postoperative complications [23.3%(10/43)]were higher than those of control group [(43.1±8.6)h,(28.5±5.8) h,(15.6±3.8) d,5.9%(5/85)](P<0.05 or <0.01).Conclusions Although there are high risks in patients aged 65 years and elderly with cardiac valve disease,the treatment results would be satisfactory ff select the right operating time and do full preparation with reasonable surgery strategy,the mortality and morbidity of postoperative complications could be reduced.

Objective To investigate the efficacy of heart value replacement on elderly patients and summarize the experience of surgical treatment.Methods The clinical data and follow-up status of 76 elderly patients were analyzed retrospectively in our hospital from January 2008 to December 2011.The operative method,general effect,postoperative death,postoperative complications,survival rate and life quality followed-up were analyzed.Results No intraoperative death appeared and there were 4 early operative deaths with a mortality rate of 5.3％.There were 31 cases occurred postoperative complication with a complication rate of 40.8％ which including respiratory insufficiency,lung infection,arrhythmia,incision infection,pleural effusion,low cardiac output syndrome and renal insufficiency.The follow-up time was 18-52 months and the mean follow-up time was (24.7± 3.6)months.There were 5 cases lost of follow up and the follow-up rate was 93.4％.There were 6 patients died after a month postoperative with a mortality rate of 7.9％.The heart function of the survivors achieved differed degree improvements and the result at the end of follow-up were grade Ⅰ-Ⅱ 47 cases,grade Ⅲ 13 cases and grade Ⅳ 6 cases.Conclusions To correctly determine the surgery indications,do all the preoperative preparation,intraoperative rigorous operating with a good myocardial protection and to strengthen the postoperative care will be help to reduce the mortality and complications of the elderly patients with heart value replacement.

Objective To investigate the risk fairs and significance of late recurrence in non-small cell lung cancer (NSCLC)patients who had undergone complete resection and remained recurrence-free for5 years.Methods 496 individuals diagnosed and surgically treated for Stage Ⅰ and Ⅱ A NSCLC were included.We examined patients at 3-month intervals for the first 2 years after surgery and typically at 6-month intervals thereafter on an outpatient basis.The follow-up evaluation included physical examination,inaging examination and tumor narkers.Pathological examination had also been performed when needed.Of these,336 patients remained recurrence-free for 5 years were followed up continuously for 3 years.Clinicopathologic factors were collected including age,sex,smoking history,preoperative serum carcinoembryonic antigen (CEA) level,surgical apprach,maximum tumor dimension on resected specimen,histologic type,histologic differentiation,intratumoral lymphatic permeation,intratumoral vascular invasion,pleural invasion and pathologic stage.The primary end event was lung cancer recurrence.The data collection ended in January 2011.Kaplan-Meier method was used for survival rate.Survival difference wasevaluated bylog-rank test.Multivariate Cox regression was used to test the relationship of recurrence-free probability to various clinicopathologic factors.Results At 5 years after resection,109 patients had died of disease and 33 had died of other causes.18 patients were alive with disease.The remaining 3 - 36 patients were alive and recurrence-free for the first 5 years.The median follow-up period of these 5-year recurrence free survivors was 27 months (range,3-36 months).34 (10.1％)patients developed a late recurrence at 3 years among the 336 patients.Recurrence was locoregional in 13 (38.2％)patients:6 patients in mediastinal lymph nodes,3 patients in ipsilateral lung,2 patients with pleural dissemination and 2 patients in other locations.Recurrence was distant in 21 (61.8％) patients:8 patients with multiple-organ metastases,13 patients with single-organ metastasis,and the latter consisted of 5 patients in contralateral lung,3 patients in liver,2 patients in central nervous system and 3 patients in other locations.Smoking history,preoperative serum CEA level,histologic differentiation,intratumoral lymphatic invasion,intratumoral vascular invasion,pleural invasion and pathologic stage were risk factors for late recurrence in univariate analysis.Multivariate Cox analysis demonstrated that intratumoral vascular invasion and intratumoral lymphatic invasion were independent risk factors for late recurrence.Conclusion NSCLC patients have a significant risk of late recurrence after complete resection 5 years,especially for the patients with intratumoral vascular invasion and intralumoral lymphatic invasion.It is needed and significant for the patients to follow up continuously after 5 years of complete resection.

[Objective]To discuss the operative treatments and evaluate the effects of reconstruction interlocking nail(RIN)in treating femoral shaft fractures associated with ipsilateral peritrochanteric fractures of the femur.[Method]A retrospective study was done on 37 patients with femoral shaft fractures combined with ipsilateral peritrochanteric fractures treated by RIN from September 2002 to Janurary 2009.This study involved 32 males and 5 females,with an average age of 36 years (range,24 to 69 years).Thirty-three patients had high-energy injury (26 of road accident,7 of falling from height),and 4 low-energy injury.Among them,13 patients had fractures in the upper one-third of the femoral shaft,18 in the middle one-third and 6 in the lower one-third.Six patients had open fractures (Gustilo scale Ⅰ in 1,and Ⅱ in 5).According to Garden classification for femoral neck fractures,there were 19 cases of type Ⅱ,9 cases of type Ⅲ and 2 cases of typ Ⅳ.According to AO classification for femoral intertrochanteric fractures,there were 3 cases of type A1.1,1 case of type A2.1.According to Seinsheimer classification for femoral subtrochanteric fractures,there was 1 case of type Ⅰ,and 2 cases of type ⅡA.The mean duration from injury to surgery was 3.7 days (range,4 hours to 13 days).After operation step-by-step functional rehabilitation was encouraged.[Result]The follow-up periods ranged from 14 to 38 months (average,24 months).Bony union was achieved in all patients.The average bony union time was 13 weeks for fractures of femoral shaft,14 weeks for femoral neck,12.6 weeks for intertrochanteric and 15.5 weeks for subtrochanteric fractures.Femoral head necrosis occurred in one case.No such complications as infection,loosening of nails,coxa vara,or malunion was found.According to Harris Scoring system,32 cases (86.5%)were rated as good or excellent.[Conclusion]The treatment of femoral shaft fractures associated with ipsilateral peritrochanteric fractures of the femur with RIN is a good method because of its advantages of small trauma,stable fixation,high union rate,few complications and good results.It may have fewer internal fixators.Carefully choosing suitable patients,sophisticated operation skills and active functional exercise after operation are keys to success.

Objective To investigate the effect of synchronous chemotherapy combined with spleen polypeptide on immune function in patients with esophageal cancer and cardiac cancer after operation. Methods Sixty postoperative patients of esophageal and esophagogastric junction carcinoma were collected in the Fourth Hospital of Hebei Medical Universitythe from March 2013 to January 2014,and were randomly divided into two groups,including 30 cases were treated with simple chemotherapy as control group,and the other 30 cases were treated with chemotherapy combined with lineal polypeptides as experimental group. Results There were no significant differences in terms of CD3,CD4 and CD4/CD8 between the two groups before operation( P>0. 05) . After two cycles of chemotherapy,the CD3,CD4,CD4/CD8 of experimental group were all significantly higher than the control group((76. 08±8. 04)% vs. (38. 58±6. 40)%,(42. 91±7. 73)% vs. (42. 91±7. 73)%,1. 31 ±0. 21 vs. 1. 16±0. 22),and the differences were significant(P=0. 037,0. 022,0. 008). The survival quality of the experimental group was better than that of the control group ( P=0. 038 ) . The proportion of patients with WBC in the normal range of the experimental group was significantly higher than that in the control group (80. 0% vs. 53. 3%,P=0. 028). The adverse reactions of the digestive system in the experimental group were lower than those in the control group, the difference was statistically significant between the two groups ( acid reflux and heartburn:26. 7% vs. 63. 3%,P=0. 004;nausea and vomiting:33. 3% vs. 73. 3%,P=0. 002;loss of appetite:46. 7% vs. 80. 0%,P=0. 007) . Conclusion The treatment of the patients with esophageal cancer and cardiac cancer after chemotherapy with spleen peptides can improve immunity,and improve the quality of life of patients after chemotherapy and chemotherapy.

Objective To optimize the technological parameters of separation and purification of vinblastine and vincristine from Gatharanthus Roseus. Methods Different types of macroporous adsorption resin were used to separate and purify vinblastine and vincristine from Gatharanthus Roseus, eluting with different concentration of alcohol aqueous and velocities, combined with silica gel column chromatography, the process was monitored by HPLC. Results AB-8 type resin showed better comprehensive adsorption property, 90% alcohol aqueous and 1.5 BV/h velocities were used to elute. Ratio adsorption quantity was achieved to 74.5 mg/g. Through silica gel column chromatography, the purity of vincristine was achieved to 97.26% and the purity of vinblastine was achieved to 94.18%. Conclusions The process is simple and reasonable with good reproducibility. It is effective to enrich highly purified vinblastine and vincristine.

Objective To investigate the effects of basic fibroblast growth factor (bFGF) on global cerebral ischemia/reperfusion (I/R) injury.Methods Twenty-four rabbits of both sexes aged 6 months weighing 2.2-3.0 kg were randomized into 3 groups ( n = 8 each) : group I sham operation; group Ⅱ I/R and group Ⅲ I/R + bFGF. The animals were anesthetized with diazepam, haloperidol and fentanyl. The right femoral artery was cannulated for BP monitoring and blood-letting. The animals were tracheotomized and mechanically ventilated (VT = 8 ml ?kg -1 , RR = 40 bpm, I: E = 1:2). PET CO2 was maintained at 40 mm Hg. Global cerebral I/R was induced by "occlusion of four vessels + hypotension" . Bilateral common carotid arteries and vertebral arteries were occluded for 30 min combined with hypotension, which was produced by blood-letting and maintained at 50%-60% of the baseline level. The four vessels were then released for reperfusion and BP was returned to baseline level by retrieval of the removed blood. In sham operation group ( Ⅰ ) the four blood vessels were exposed but not occluded. In group Ⅲ a loading dose of 30 ?g?kg-1 bFGF was given Ⅳ at the end of 30 min ischemia followed by bFGF infusion at 10 ?g? kg-1? h-1 for 6 h. In I/R group ( Ⅱ ) normal saline was given IV instead of bFGF. Blood samples were taken before I/R (T0 , baseline) and at 0, 0.5, 1, 3, 6 h (T1-5) of reperfusion for determination of serum neuron specific enolase (NSE) and S-100B concentrations. At the end of the experiment the animals were killed and brains removed for determination of brain water content and microscopic examination. Results Serum NSE and S-100B concentrations in group Ⅱ and Ⅲ were significantly increased at T4 5 as compared to the baseline (T0) and were significantly higher at T4 5 than those in sham operation group ( Ⅰ ) . Serum NSE and S-100B concentrations were significantly lower in group Ⅲ (I/R + bFGF) than in groupⅡ (I/R). Serum NSE and S-100B were positively correlated ( r = 0.736, P

BACKGROUND: It is manifested in epidemiology and clinical observation that lipoprotein (a) is a new risk factor of cerebrovascular disease and is closely related to cerebral ischemic stroke.OBJECTIVE: To discuss the relationship between levels of high serum lipoprotein (a) and stroke.DESIGN: Case controlled analysis.SETTING: Neurological Institute of Xiangya Hospital of Central South University.METHODS: Totally 294 patients with stroke were selected from Neurological Department of Xiangya Hospital of Central So, uth University between September 1999 and March 2002. Of them, 159 cases were regarded as cerebral infarction group and other 135 cases as acute hypertensive cerebral hemorrhage group. In cerebral infarction group, 109 patients had atherosclerotic cerebral infarction and 50 patients had lacunar cerebral infarction, and 94patients with contimuous health examination were regarded as health examination group. Serum lipoprotein (a) in each group was assayed with "sandwich enzyme-linked immuno-sorbent assay". According to whether the value of lipid was normal or not, patients with atherosclerotic cerebral infarction and acute hypertensive cerebral hemorrhage were divided into two groups. Comparisons between the two groups were assayed with single sample t test, and multiple liner regression was used to assay whether sex, hypertension and value of lipid were related to the level of serum lipoprotein (a).MAIN OUTCOME MEASURES: ① Comparisons of serum lipoprotein (a)among atherosclerotic cerebral infarction group, lacunar cerebral infarction group, acute hypertensive cerebral hemorrhage group and health examination group. ② Correlated analysis between serum lipoprotein (a) and lipid.RESULTS: Among 294 patients, 94 cases in control group entered the final analysis. ① Comparisons of serum lipoprotein (a) among atherosclerotic cerebral infarction group, lacunar cerebral infarction group, acute hypertensive cerebral hemorrhage group and health examination group: Levels of serum lipoprotein (a) in atherosclerotic cerebral infarction group and cerebral hemorrhage group were higher than those in health control group (P ＜ 0.05), and concentration of lipoprotein (a) in atheroosclerotic cerebral infarction group was increased as compared with that in acute hypertensive cerebral hemorrhage group (P ＜ 0.05). Also, level of lipoprotein (a) in lacunar cerebral infarction group was a little higher than that in control group,but the difference was not significant (P ＞ 0.05). ② Correlated analysis between serum lipoprotein (a) and lipid: Levels of lipoprotein (a) in both normal lipid group and abnormal lipid group were assayed with single sample t test, and the results showed that levels in the two groups were similar (P ＞ 0.05). Multiple liner regression was used to assay whether sex,hypertension and value of lipid were related to level of serum lipoprotein (a).CONCLUSION: Levels of lipoprotein (a) may be an independent risk factor for cerebral hemorrhage and atherosclerotic cerebral infarction.

Endoscopic retrograde cholangiopancreatonraphy (ERCP) is the main treatment modality for common bile duct stone.Biliary hemorrhage easily occurred in patients suffering from cirrhosis during and after ERCP.From May 2012 to May 2016,8 cases diagnosed with cirrhosis and common bile duct stones who developed post-ERCP refractory biliary hemorrhage were treated with full-covered self-expanding removable metal stents (FCSERMS),including 5 cases with perioperative hemorrhage of ERCP and 3 cases with delayed onset of biliary hemorrhage post ERCP.All the patients were successfully implanted with FCSERMS.Seven patients had successful hemostasis,and the other one case with ineffective hemostasis was treated with interventional arterial embolization later.Four stents were removed within 4 weeks and one in 8 months after ERCP.No evidence of biliary hemorrhage,intestinal fistula and other complications was observed during removal procedures.Spontaneous stent dislodgment occurred in one patient in postoperative 4 weeks,one patient died of liver failure in postoperative 6 months and one patient carried FCSERMS for 23 months.