[Summary] Minimally invasive hybrid coronary revascularization ( MIHCR) represents a minimally invasive revascularization strategy that combines coronary artery bypass graft ( CABG) surgery with percutaneous coronary intervention ( PCI) .Although MIHCR is better than coronary artery bypass graft surgery in theory , there is no useful randomized controlled trial to prove the advantage of MIHCR in recent medical papers .In this paper , we reviewed different aspects of MIHCR , such as basic definitions , basic rationale , indications , operation selection and current problems .

Objective To observe the effect of low-frequency, repetitive transcranial magnetic stimulation ( rTMS) at different frequencies on the cognitive function of traumatic brain injury patients with a history of epilepsy. Methods Sixty traumatic brain injury patients were randomly divided into a 0. 5 Hz group, a 1. 0 Hz group and a control group, each of 20. In addition to routine drug therapy and cognition training, the control group was given fake stimulation, the 0.5 Hz group was treated with 0.5 Hz rTMS, and the 1.0 Hz group was provided with 1.0 Hz rTMS for 4 weeks, eleven times per week. Before and after treatment, the cognitive function of all three groups was assessed using the Montreal cognitive assessment ( MOCA) , the Rivermead behavior memory test ( RBMT) and a symbol can-cellation test. The number of patients reporting headache or epilepsy during the treatment period was also counted. Results During the treatment, there was no headache case in any of the groups, and no significant difference was found in the occurrence of seizures. After the treatment, all of the measurements in all 3 groups had improved signifi-cantly. The average MOCA and RBMT scores in the 1.0 Hz group were all significantly better than those in the control group, but there was no significant difference between the 0.5 Hz group and the control group. The symbol cancella-tion test efficiency of the 1. 0 Hz group was not significantly better than that of the 0. 5 Hz and control groups. Conclusions Repeated 1.0 Hz transcranial magnetic stimulation can significantly improve cognition after traumatic brain injury among patients with a history of epilepsy without increasing the risk of seizures.

Objective:To investigate the effect of miRNA-1-3p (miR-1-3p) on expression of myocyte enhancer factor 2A (MEF2A) and the biological function of osteosarcoma cells.Methods:The tumor tissues and adjacent normal tissues of 20 patients with osteosarcoma who were clinically diagnosed in Shanxi Provincial Cancer Hospital from January 2019 to January 2020 were collected, and the expression of miR-1-3p in the samples was detected by real-time fluorescent quantitative polymerase chain reaction (qRT-PCR). The expression of miR-1-3p in osteosarcoma cell lines U2-OS, SAOS-2, MG63, SW1353 and human normal osteoblast cell line hFOB1.19 was detected by qRT-PCR, then the cell line with the lowest expression of miR-1-3p was selected for follow-up experiments. An overexpression miR-1-3p vector was constructed (miR-1-3p mimcs). The miR-1-3p overexpression group was transfected with miR-1-3p mimcs, and the control group was transfected with empty vector (miR-1-3p nc). CCK-8 method was used to detect the proliferation activity of cells; flow cytometry was used to detect the changes of cell apoptosis and cell cycle. miRwalk database was used to predict the miR-1-3p target gene, and the target gene was verified by dual-luciferase reporter gene assay; Western blot was used to detect the expression of MEF2A protein in cells of each group.Results:Compared with adjacent tissues, the expression of miR-1-3p in osteosarcoma tissues was down-regulated (0.31±0.14 vs. 0.62±0.21), and the difference was statistically significant ( t = 5.31, P<0.01). The expression of miR-1-3p in U2-OS cells was the lowest; compared with the control group, the proliferation activity of U2-OS cells was inhibited in miR-1-3p overexpression group (48 h absorbance value 0.56±0.01 vs. 0.77±0.03, t = 2.77, P<0.01; 72 h absorbance value 0.87±0.02 vs. 1.40±0.03, t = 2.93, P<0.01); G 1/S cell cycle arrest increased [G 1 phase (38.24±0.55)% vs. (32.11±0.80)%, t = 9.27, P = 0.01; S phase (61.24±0.90)% vs. (67.78±0.83)%, t = 7.52, P = 0.02]; early apoptotic rate increased [(11.20±0.12)% vs. (1.50±0.12)%, t = 2.91, P<0.05], miRwalk database predicted that the miR-1-3p target gene was MEF2A. The result of dual-luciferase reporter gene assay showed that miR-1-3p bound to MEF2A 3'UTR, and the luciferase activity of U2-OS cells in miR-1-3p overexpression group was lower than that in the control group (renilla luciferase/firefly luciferase activity ratio 0.53±0.06 vs. 1.00±0.04, t = 4.04, P < 0.05). Western blot showed that the expression of MEF2A protein in U2-OS cells of miR-1-3p overexpression group was lower than that of the control group (protein relative expression 0.41±0.14 vs. 0.77±0.12, t = 3.93, P < 0.05). Conclusions:The low expression of miR-1-3p may be associated with the proliferation, apoptosis and cycle changes of osteosarcoma cells. miR-1-3p can negatively regulate the expression of MEF2A protein and regulate the occurrence and development of osteosarcoma.

Objective To investigate the relationship between serum uric acid (SUA) and metabolism syndrome (MS) in community-based elderly population in Beijing.Methods A community-based and cross-sectional survey on 1821 elderly person was performed in Beijing in 2000.Questionnaire survey,physical examination and blood biochemical tests were conducted.Relationship of MS and its components with SUA was analyzed.Results Among 1821 subjects,there were 365 cases with MS (20.0％) and 1456 cases without MS (80.0％).SUA level was higher in MS group than in non-MS group [(5.20±2.27) μmol/L vs.(4.50±1.44) μmol/L,t=-7.34,P=0.000].All subjects were divided into 4 groups according SUA level:goup 1 (≤3.5μmol/L,n=443),group 2 (3.6 μmol/L-4.4 μmol/L,n=465),group 3 (4.5 μmol/L-5.4 μmol/L,n=446) and group 4 (≥5.5 μmol/L,n=467).SUA level was increased along with the increased BMI,TG,TC,LDL-C levels,and decreased along with the decreased HDL-C level,which had significant differences (F=43.07,9.32,22.36,8.19,9.39,all P＜0.001).There were significant distribution differences in MS components numbers in the 4 groups (x2=73.62,P=0.000).After adjusting for age,sex,residential,education level,marriage,smoking,drinking and exercise habits,logistic regression analysis showed that MS was related with SUA level,and the risk of MS was increased along with the increased SUA level.Conclusions MS is correlated with SUA level in elderly people.SUA level should be observed and controlled effectively in the elderly.

Objective To explore the change of the pre-swallow peak pressure of upper esophageal sphincter (UES) in patients with post-stroke cricopharyngeal achalasia,and investigate the effect of pre-swallowing peak UES pressure on swallowing function by quantitative analysis.Methods Fifty-seven stroke patients with cricopharyngeal achalasia were recruited and divided into balloon dilation group,combined training group and routine swallowing training group with 19 patients in eachp.All the three groups accepted routine swallowing training.In addtion,the routine swallowing training group and balloon dilation group accepted larynx elevation training and balloon dilation training,respectively,while the combined training group accepted larynx elevation training and balloon dilation training simultaneously.The pre-swallow peak UES pressure was measured by using PC polygraph high rate gastrointestinal dynamical detection system (PC Polygraf HR,CTD-synectics,Sweden) before and after 8 weeks of treatment.The swallowing function was assessed using swallowing function classification and water swallowing test.Results Before treatment,there was no significant difference among the 3 groups in terms of the pre-swallow peak UES pressure,swallowing function classification,water swallowing test and VFSS (P ＞ 0.05).After treatment,pre-swallow peak UES pressure,swallowing function classification,water swallowing test and VFSS of the balloon dilation group and combined training group improved significantly compared with those before treatment (P ＜ 0.05),and the improvement in the combined training group was to a significantly better extent than in the balloon dilation group(P ＜O.05).Conclusion Balloon dilation and larynx elevation training plus routine swallowing training can increase pre-swallow peak UES pressure,decrease the UES resting pressure of stroke patients with cricopharyngeal achalasia,which is of great importance for their recovery.

Objective To observe the effect of different ways of balloon catheter dilation techniques on cricopharyngeal achalasia and its mechanisms.Methods Thirty patients with deglutition disorder after brain stem infarction,whose cricopharyngeal achalasias were proven by videofluoroscopic swallowing study(VFSS),were randomly divided into three groups: No.14 conventional catheter group A,No.14 modified bicavitary silica-gel catheter group B and No.22 conventional catheter group C with 10 cases in each group,respectively.All the patients of 3 groups received multiple times corresponding balloon catheter dilatation per nasal or per os(No.22 conventional catheter group C only per os).Results After an average of 30 d of balloon catheter dilatation,the level of dysphagia and VFSS evaluation of all patients improved significantly(P ＜ 0.05).However,the No.14 conventional catheter group A and No.22 conventional catheter group C improved to a greater extent than No.14 modified bicavitary silica-gel catheter group B(P ＜ 0.05).The saccule perimeter,saccule diameter and saccule intracapsular pressure of No.14 conventional catheter group A and No.22 conventional catheter group C increased significantly(P ＜ 0.05)when compared to those of No.14 modified bicavitary silica-gel catheter group B,but there was no significant diffference beween No.14 conventional catheter group A and No.22 conventional catheter group C(P ＞ 0.05).Conclusions The balloon catheter dilation technique can significantly improve swallowing function of deglutition disorders patients with cricopharyngeal achalasia after brain stem infarction,which is related positively to saccule diameter and saccule intracapsular pressure.

BACKGROUND: It is discovered by administrating different emetics to vomiting animals, like cats, that there are a large amount of Fos positive neuronal expressions in the arc region from nucleus of solitary tract, lateral tegmentum to ventrolateral area. And it has been viewed that the arc region from area postrema, nucleus of solitary tract to ventrolateral reticular structure is the main emetic region. Whether do the non-vomiting animals reflect in response or not after emetic injection?OBJECTIVE: To observe the distribution of Fos positive neurons in relevant emetic regions of brain and spinal cord in rats after abdominal injection of emetic, cisplatin.DESIGN: Randomized controlled experiment based on animals.SETTING: Neural Physiological Research Room of Life Science College in Hebei Normal University and Physiological Room of Basic Medicine Institute in Hebei Medical University.MATERIALS: The experiment was performed in Neural Physiological Research Room of Life Science College in Hebei Normal University and Physiological Room of Basic Medicine Institute in Hebei Medical University from March to August 2003. Twelve SD male rats were employed, body weighted varied from 220 to 250 g, of clean-grade. They were randomized into experimental group of 6 rats and the control of 6 rats.INTERVENTIONS: In experimental group, the emetic, cisplatin, was injected abdominally 10 mg/kg. In the control, the physiological saline of same dose was injected. Afterwards, the activity changes in rats were observed at room temperature, quiet and light-avoided environment. Six hours later, the brain tissue was collected for frozen continuous sectioning. Immunohistochemical staining method was used to observe the distribution of Fos positive neurons in brainstem and forebrain nuclei and to count positive cell.MAIN OUTCOME MEASURES: ① Behavior observation in rats after emetic injection. ② Counts of Fos positive cell in relevant regions of brain in rats.RESULTS: Twelve rats all entered result analysis. ① In 20 minutes after injection, the rats in both groups were in tranquilizing state, lying prone with body curled, almost without any movement. In 60 minutes after injection, the rats in the control were recovered to normal, free of eating or drinking. The rats in experimental group were in prone-lying state with body curled. They rose up or shook the heads occasionally, and they breathed fast and uneven.In 2 hours after injection, in experimental group, the rats were still in abdominal prone tightly in the cage, with heads lowed and irregular shaking of noses. In 5 hours, the rats in experimental group began standing up and moving, with normal breathing, but they still did not eat or drink. ② Fos positive neurons in solitary tract, area postrema and lateral parabrachial nucleus and paraventricular nucleus, supraoptic nucleus and arc nucleus in hypothalamus (64.3 ±9.6, 83.4 ±15.0, 148.8 ±19.9, 80. 2 ± 11.8, 20.7 ±3.8, 86. 6 ± 10.8) were remarkably higher than those in the control(56. 2 ±6.3,73.5±9.9,136.9±17.8,66. 1±10.3,17.3±3.4,78.8±10.5).CONCLUSION: Emetics induce discomforts in internal organs of rats, due to which, there probably exist emetic regions similar to vomiting animals in central neural system. But it is probably lack of vomiting-related adjusting mechanism. Emetics irritate the increase of Fos positive neurons in relevant regions in the brain of rat, which suggests that there exist relevant neural chemical pathways similar to nausea in the brain of non-vomiting rats.

Objective To investigate the significance of anti-mutated citrullinated vimentin(MCV)an- tibody in rheumatoid arthritis(RA)and study the correlation among anti-CCP,other antoantibodies and clinical manifestations of RA.Methods Anti-MCV antibody was detected by enzyme-linked immunosorbent assay (ELISA)in 166 serum samples including 74 from RA(18 cases with early RA and 56 cases with late RA),50 from non-RA rheumatic diseases and 42 cases of healthy blood donors.At the same time,other antuoantibod- ies were detected by different techniques,and their clinical meaning was investigated with the corresponding clinical data.Results Anti-MCV was found in 78%(58/74)of RA.The sensitivity and specificity of Anti- MCV in RA were 78% and 95%.The positive and negative predictive value was 97% and 71%.The average cut off concentration of Anti-MCV was(552?380)U/ml in RA,(162?63)U/ml in non-RA and(63?46)U/ml in healthy control.Anti-MCV was strongly correlated to anti-CCP(r=0.502,P=0.000),then AKA(r=0.408)anti APF(r=0.369).No differences was found between Anti-MCV and other clinical/laboratory parameters(P＞0.05). Conclusion Anti-MCV antibody may be a valuable diagnostic parameter for RA.Anti-MCV is more strongly correlated to anti-CCP than APE and AKA.It may not relate to disease activity and/or severity.

Objective To observe the influence of transplanting neural stem cells (NSCs) on angiogenesis in rats with spinal cord injury (SCI).Methods The Allen's method was used to create SCI models in sixty adult Sprague-Dawley (SD) rats.They were then randomly classified into a control group which received injections of phosphate buffered solution (PBS) and an NSC group which received injections of NSCs via the tail vein,with 30 rats in each group.Another group of 30 similar rats without SCI received injections of NSCs via the tail vein as the normal group.Each rat was evaluated before transplantation and at days 7 and 14 post-transplantation using the Basso,Beattie and Bresnahan (BBB) scale for testing hindlimb function.After sacrifice,the distribution of yon Willebrand factor (vWF) in both groups was determined by immunofluorescence,and Western blotting was used to detect vascular endothelial growth factor (VEGF) protein.Results The average BBB score of the normal group was 21 at every time point.Before transplantation,the BBB scoresof the control and NSC groups were both 0,however they increased over time.At day 7 post-transplantation,the BBB scores showed no significant difference between the control group and the NSC group.At day 14 post-transplantation,the average BBB score of the NSC group was significantly higher than that in the control group.At days 7 and 14,the counts of vWF-positive cells in the normal group were significantly higher than in the control and NSC groups.VEGF protein expression in the normal group was significantly lower than in the NSC and control groups.Conclusions NSC transplantation may promote angiogenesis after spinal cord injury and improve motor function by inducing the expression of VEGF.

Objective To investigate the therapeutic effect of stage treatment of severe complicated injuries in palmar forearm and wrist.Methods From March 2008 to Novemler 2011, eleven cases with skin lost combined with fracture and lost of flexor tendon, ulnar radial arteries, median and ulnar nerves,and some of them had fracture of ulnar and radius were treated in the first stage with vacuum sealing drainage after emergency debridement and tissue repair. Secondary microsurgical repair was performed after the VSD was removed. The lost of median and ulnar nerves was repaired with transplantation of sural nerve,and the wound was repaired with free flaps and complex tissue flaps. Results Eleven cases were treated with vacuum sealing drainage for 7 to 10 days.Infections were under control,wound areas reduced and most wound areas were covered by granulation tissues.Flaps and skin grafts were survived.After postoperative follow-up for 3 to 36 months (average 13 months),three cases was received flexor tendolysis.As result,the blood circulation of hand was good, the sensor of injured nerve was higher than S3, and there was a good functional rehabilitation of hand muscles. Conclusion Using vacuum sealing drainage after emergency debridement and tissue repair, there was a good repairing effect of secondary repair with flaps and skin grafts for severe complicated tissue defect in palmar forearm and wrist,and it is an effective choice of operation.