ObjectiveSurgical radiofrequency (RF) ablation has recently been one of the most effective means to treat chronic atrial fibrillation(AF).However,about 20％ to 30％ patients have shown recurrence of AF during the follow-up period.This study retrospectively analyzed AF recurrence rate in those patients who underwent valve replacement procedures combined with RF ablation to treat AF in our department during the last three years.We compared the information and clinical date in the sinus rhythm(SR) group with in the AF recurrence group to analyze the relationship between various preoperative risk factors and operation failure.The aim of this study is to provide evidences to select patients who can benefit most from this type of surgery and to reduce their surgical risk and hospital charges.MethodsFrom June 2006 to June 2009,52 patients with rheumatic heart disease (RHD) and chronic AF underwent RF ablation concomitant with valve replacement in our department by a same surgeon with the same method.Preoperative and intraoperative data was retrospectively collected and all patients were followed up longer than six months to determine the type of heart rhythm.Operation failure was defined as showing any rhythm except normal sinus rhythm by electrocardiogram.We divided all patients to the SR grope and AF grope.Univariate and multivariate statistical analysis was used to compare the data between the two groups in pre-,intra- and postoperative period.Results There was only one case in-hospital mortality ( 1.9％ ).None mortality,re-exploration for bleeding and pacemaker implantation for malignant arrhythmia was shown during the mean follow-up period of 14 months (9-35 months).At the last follow-up,sinus rhythm was shown in 71.2％ (37/52) patients.In univariaye analysis,the left atrial diameter,AF duration,left ventricular end diastolic volume and aortic cross-clamp were predictors of recurrence of AF.Age,left ventricular ejection factor,cardiopulmonary bypass time showed no significant difference between the two gropes.Multivariate analysis showed that AF duration was the independent risk factor of recurrence of AF after the bipolar radiofrequency ablation procedure.ConclusionRF ablation concomitant with valve replacement is an effective way to treat AF for those patients who need open heart surgery at the same time.Patients with normal SR may gain a better life quality.Preoperative duration of AF was the independent risk factor of AF recurrence.The longer the duration of AF is,the worse the efficacy of this procedure to restore normal SR is.

Objective To study the optimal radiographic conditions for patients with knee arthroplasty (TKA) and the feasibility of clinical application.Methods According to the different exposure modes,including automatic exposure control (AEC) or manual exposure mode (FIXED),the human body specimen was exposed at a certain kV and different mA or mAs.The entrance surface dose (ESD) and dose exposure index(DEI) were recorded,and the subjective image quality was assessed.The test group with optimum parameters obtained with statistical analysis were compared with control group in radiation dose and subjective evaluation.Results In AEC group,ESD and kV showed a negative correlation (r =-0.973,P ＜ 0.05).At the same mA,DEI was firstly decreased and then increased with kV increasing.The subjective image quality score was (1.96 ± 0.56).DEI and physician ratings showed negative correlation (r =-0.840,P ＜ 0.05).In FIXED group,ESD increased with the increasing mAs (r=0.845,P＜0.05).DEI and kV,mAs indicated a positive correlation(r=0.845,P＜0.05).The subjective image quality scores was(4.33 ±0.79) without correlation with DEI.Compared with the control group,the subjective image quality scores of test group increased,and the radiation dose decreased significantly.Conclusion It is optimal using manual exposure mode with 80 kV/l.25-1 mAs,75 kV/2-1 mAs,70 kV/2.5-1.25 mAs,65 kV/3.2-1.6 mAs and 60 kV/3.2-2 mAs for patients with TKA.

OBJECTIVEDiscrete potentials (DPs) have been recorded and targeted as the site of ablation of the outflow tract arrhythmias. The aim of the present study was to investigate the significance of DPs with respect to mapping and ablation for idiopathic outflow tract premature ventricular contractions (PVCs) or ventricular tachycardias (VTs).

METHODSSeventeen out of 24 consecutive patients with idiopathic right or left ventricular outflow tract PVCs/VTs who underwent radiofrequency catheter ablation between September 2012 and December 2013 in our department were included. Intracardiac electrograms during the mapping and ablation were analyzed.

RESULTSDuring sinus rhythm, sharp high-frequency DPs that displayed double or multiple components were recorded following or buried in the local ventricular electrograms in all of the 17 patients, peak amplitude was (0.51 ± 0.21) mV. The same potential was recorded prior to the local ventricular potential of the PVCs/VTs. Spontaneous reversal of the relationship of the DPs to the local ventricular electrogram was noted during the arrhythmias. The DPs were related to a region of low voltage showed by intracardiac high-density contact mapping. At the sites with DPs, unipolar and bipolar ventricular voltage of sinus beats were lower compared with the adjacent regions without DPs (unipolar: (6.1 ± 1.8) mV vs. (8.3 ± 2.3) mV, P < 0.05; bipolar: (0.62 ± 0.45) mV vs. (1.03 ± 0.60) mV, P < 0.05). The targeted DPs were still present in 12 patients after successful elimination of the ectopies. Discrete potentials were not present in seven controls.

CONCLUSIONSDiscrete potentials and related low-voltage regions were common in idiopathic outflow tract ventricular arrhythmias. Discrete potential- and substrate-guided ablation strategy could help to reduce the recurrence of idiopathic outflow tract arrhythmias.

Objective To explore the ideal choice of feeding artery which is used for regional arterial infusion (RAI) in severe acute pancreatitis. Methods Forty-five patients with SAP were treated with RAI. The ideal feeding artery was that can supply entire pancreas according to arteriography and can maximize concentration of drug at pancreatic tissue. The pancreatic arteriography was considered as the final objective evidence for choice. Results (1)Gastroduodenal artery was chosen as feeding artery in forty-four cases, and superior mesenterlc artery was chosen in only one case because of vascular abnormity. (2)According to splenic arteriography, blood of splenic artery was supplied to spleen chiefly, and only partial tail of pancreas was applied by splenic artery. (3)According to celiac trunk arteriography, blood of celiac trunk could be supplied to entire pancreas, but a considerable proportion of the total blood was supplied to spleen through splenic artery and liver through hepatic artery proper.Therefore, the drug utilization index was lower. (4)According to gastroduodenal arteriography, blood of gastroduodenal artery could be supplied to entire pancrea, and almost all of the blood that contains drug flowed into pancreas. Therefore, the drug utilization index was higher. Conclusions Gastroduodenal artery is the ideal choice of artery which is used for regional intra-arterial infusion in sever acute pancreatitis. Pancreatic arteriography should be applied routinely when yever acute pancreatitis was treated with RAI.

Objective To study the effects of decoy strategy targeted to NF-KB on the development of trauma-associated liver inflammation in rats. Methods In this study, 108 Wistar rats were randomized into 3 groups: control group, traumatic inflammation group and traumatic inflammation plus decoy ODN group. Rats were sacrificed on 3,6,12,24,48 and 72hrs in each group respectively. Liver functions and structural changes were examined and compared between the groups. DNA binding activity of NF-KB in liver tissue was measured by EMSA. TNF-α and IL-6 gene expressin in liver tissue was assessed by RT-PCR and TNF-α and IL-6 protein level was determined by ELISA. Results The DNA binding activity of NF-kB in liver rose at 3 hours after induction of liver inflammation following trauma and peaked at 12 hours. Correspondingly, both the mRNA and protein levels of TNF-α and IL-6 elevated significantly, as well as the serum alanine aminotransferase level culminating at 24 hours after surgery. Hepatocytes was edematous, degeneration and necrosis, with dramatic destruction of lobular structures. All these changes were significantly inhibited with NF-KB decoy oligodeoxynucleotides. Conclusions Decoy oligodeoxynucleotides specifically inhibit the activity of NF-kB, and the release of pro-inflammatory cytokines, TNF-α and IL-6 release from the liver in response to traumatic inflammation decrease, hence the injury on liver structures and functions were alleviated.

Objective To study the effects of decoy strategy targeted to NF-?B on IL-6 in rat's liver after traumatic inflammatin. Methods Ninty six Wistar rats were randomly divided into 4 groups: control group,traumatic inflammation group, decoy ODN group, and mutant decoy ODN group. Rats were killed on 3 , 6, 12, 24, 48 , and 72 h respectively, for the determination of plasma ALT. Hepatocytes were isolated and nuclear protein was extracted, DNA binding activity of NF-?B was measured by EMSA. Decoy ODN's competition inhibition effect was assayed by EMSA. IL-6 gene expression in liver tissue was assessed by RT-PCR and IL-6 protein level was determined by ELISA. Results After traumatic inflammation, DNA binding activity of NF-?B in the liver increased. IL-6 mRNA and protein level also significantly increased and was in positive correlation with the activity of NF-?B. Decoy ODN effectively inhibited the activity of NF-?B ex vivo. After using decoy ODN, IL-6 mRNA and protein levels of liver tissue significantly decreased, plasma ALT levels were also significantly decreased. Conclusions Decoy strategy targeted to NF-?B could effectively inhibit rat's liver IL-6 release by inhibiting specifically the activity of NF-?B.

Objective To study the expressions of DD3 mRNA and PSA mRNA in the prostate tissues and its diagnostic value in prostate cancer (PCa). Methods DD3 mRNA and PSA mRNA were detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction ( FQ-RT-PCR) based on Taqman technique in the tissues of 21 cases of PCa and 39 cases of BPH. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of DD3 mRNA, PSA mRNA and DD3 mRNA/PSA mRNA. Results The expressions of DD3 mRNA and PSA mRNA, and DD3 mRNA/ PSA mRNA were significantly higher in PCa tissues than those in BPH tissues ( P 0.05 for all). The AUC-ROC of DD3 mRNA,PSA mRNA and DD3 mRNA/PSA mRNA were 0. 937 (95% CI,0. 879 -0. 995) , 0.755(95% CI,0.629 -0.880) and 0.839 (95%CI,0.738 -0.940),respectively. The sensitivity for DD3 mRNA,PSA mRNA and DD3 mRNA/PSA mRNA was 90. 5% ,81. 0% and 81. 0% , respectively, and the specificity was 85.0% ,62.0% and 66.7% at cutoff value of 1.4?105 copies/mg tissue,3.0?107 copies/ mg tissue and 5. 0?10-3,respectively. The sensitivity and specificity of simultaneous detection for DD3 mRNA and PSA mRNA were 100% and 85.0%. Conclusions Both DD3 mRNA and PSA mRNA expressions were significantly higher in PCa tissues than those in BPH tissues; and the quantitative detection of DD3 mRNA is more helpful for the diagnosis. The simultaneous detection of DD3 mRNA and PSA mRNA can improve the sensitivity in the diagnosis of PCa.

The concept of benefit finding, the assessment tools and the status quo of benefit finding for family caregivers of stroke patients were elaborated, the influencing factors of benefit finding of family caregivers of stroke patients were summarized, the current problems and the development direction of future research were pointed out, aiming to provide a reference for clinical staff to conduct research on benefit finding of family caregivers of stroke patients in China.