source water.

Objective To assess the effects of gastric bypass versus medical therapy in patients with obesity and type 2 diabetes. Methods The Cochrane library, Embase, PubMed, Chinese biomedical literature database and Wanfang database up to April 2014 were searched. Randomized controlled trails(RCTs) of frequently-used bariatric surgery for obese patients with type 2 diabetes were included. Study selection, data extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Results Four RCTs involving 157 patients in the gastric bypass groups and 152 patients in the medical therapy group were enrolled. Compared with medical therapy, gastric bypass for type 2 diabetes significantly decreased the levels of HbA1C(mean difference = -1. 85% , 95% CI -2. 15 ~ -1. 56, P< 0. 01), fasting blood glucose( standard mean difference = - 0. 90 mmol/ L, 95% CI-1. 24 ~ -0. 57, P<0. 01), body weight(mean difference=-23. 39 kg, 95% CI -29. 17 ~ -17. 61, P<0. 01), waist circumference(mean difference= -15. 36 cm, 95% CI -17. 51 ~ -13. 22, P<0. 01) and the dose of hypoglycemic medicine; while it increased the number of patients with HbA1C<6% (RR=5. 49, 95% CI 2. 22 ~ 13. 56, P<0. 01), the rate of adverse events(RR=1. 96, 95% CI 1. 42 ~ 2. 70, P<0. 01), and the level of high-density lipoprotein-cholesterol(mean difference=1. 24 mmol/ L, 95% CI 0. 64 ~ 1. 84, P<0. 01). Conclusions Gastric bypass surgery is more effective compared with medical therapy alone for obese patients with type 2 diabetes. Further intensive RCTs of high-quality in multiple centers with long-term follow-up should be carried out to provide more reliable evidences.

OBJECTIVE To probe the pathogen′s distribution of ventilator-associated pneumonia(VAP),in order to offer the evidence of clinical therapy,prevent the onset of VAP and apply the antibiotics reasonably.METHODS We applied the methods of etiology,microscopic identification,bacteria culturing etc on 74 mechanical ventilation patients,and analyzed the etiology of early-onset and late-onset VAP in contrast.RESULTS Totally 121 pathogens were cultivated altogether in all 74 VAP patients.In the 36 pathogens which were cultivated from 29 early-onset VAP patients,there were 66.67% of simple culture(24 patients,24 strains) and 33.33% of co-culture(5 patients,12 strains),and in the 85 pathogens which were cultivated from 45 late-onset VAP patients there were 17.64% of simple culture(15 patients,15 strains) and 82.35% of co-culture(30 patients,70 strains).The proportion of co-culture in the late-onset VAP patients was prominantly higher than that in the early-onset ones(?2=27.821,P

1000 ml per day had to be cured by operation.

OBJECTIVE:To systematically review the efficacy of folic acid in the prevention of gastrointestinal(GI)tumors in elder,and provide evidence-based reference for the clinical treatment. METHODS:Retrieved from Cochrane Library,PubMed,EM-Base,Web of Science,CMB,CJFD,VIP and Wanfang Database,the randomized controlled trials (RCT) about folic acid (test group)versus placebo(control group)in the prevention of GI tumors in elder(age>50 years old). After quality evaluation and da-ta extract,Meta-analysis was performed buy using Rev Man 5.3 statistics software. RESULTS:A total of 9 RCT were included,in-volving 29 494 patients. Results of Meta-analysis showed there was no significant difference in the incidence of GI tumors between 2 groups[RR=0.91,95%CI(0.74,1.12),P=0.38]. Results of subgroup analysis showed the incidence of GI tumors was not affected by GI tumor stage,age,basic serum folic acid level,type and dose of folic acid and follow-up time during follow-up period. CON-CLUSIONS:Folic acid supplement can not effectively prevent the incidence of GI tumors in elder. The incidence of GI tumors in elder with different ages and baseline of folic acid are not decreased by any dose and duration,without obvious adverse reactions. It indicates that folic acid supplement should be careful and give full conscideration to the patients’general situation. Due to the limit of methodological quality and sample size,it remains to be further verified with more rigorously designed and long-term follow-up of large-scale RCT.

Objective To discuss the preliminary experience of transcatheter aortic valve implatantion in patients with severe aortic valve stenosis. Methods The baseline characteristics, hemodynamic changes and clinical outcomes of the patients received TAVI in our institution were analyzed. Results A total of 36 patients underwent TAVI between April 2012 and March 2014. The mean age was (73.4±8.7) years and 24 (66.7%) of them were men. The mean logistic EuroSCORE was (20.6±9.9)%. 25(70%) patients had bicuspid aortic valves. TAVI was successful in 35 patients (97.2%) and valve-in-valve implantation was required in 4 (11.1%) of them. After the procedure, the mean aortic-valve gradient reduced to (10.5±5.7) mmHg. In 2 patients (5.6%), there was marginal moderate periprosthetic leak. At 30 days, the survival rate was 97.2%. Two patients (5.6%) developed who later showed fuel recovery, without significant sequela. Permanent pacemakers were implanted in 10 patients (27.8%) due to the onset of third-degree atrioventricular block after TAVI. To date, the median follow-up duration has exceeded 323 days. 2 patients died of cancer on 374 days and 680 days after TAVI, respectively. Conclusions TAVI is feasible, safe and effective in treating severe stenosis of bicuspid as well as tricuspid aortic valve in selected Chinese patients unsuitable for surgery.

Objective To study the feasibility and accuracy of real-time three-dimensional transesophageal echocardiography (RT 3D-TEE) in measuring the aortic annulus dimension(AAD),and compared with CT measurements.Methods The AAD was measured by transthoracic echocardiography (TTE),transesophageal echocardiography(TEE) and RT 3D-TEE in 26 cases who were refered to our center for transcatheter aortic valve implantation(TAVI).Cross-sectional RT 3D-TEE can offer the AAD derived from the aortic annulus area,the maximal AAD,the minimal AAD and the eccentric index(the maximal AAD/the minimal AAD).The echo dimensions were compared with the CT measurements.Results No statistically significant differences were found between RT 3D-TEE and CT,and they have the best correlation(r =0.92,P ＜ 0.05).Meanwhile,There was no statistically significant difference in the eccentric index of the AAD between RT 3D-TEE and CT(1.25± 0.12 vs 1.28± 0.13,P ＞0.05).Conclusions RT-3D TEE imaging not only measure the AAD accurately,but also provide the maximal AAD,minimal AAD and the eccentric index for TAVI.

Objective To explore the feasibility of biplane-transesophageal echocardiography (Bip-TEE) in measuring the aortic annulus dimension (AAD).Methods Totally 24 patients underwent transcatheter aortic valve implantation (TAVI) were collected,and their AAD was measured by two-dimensional transthoracic echocardiography (2D-TTE),two-dimensional transesophageal echocardiography (2D-TEE),Bip-TEE and three-dimensional transesophageal echocardiography (3D-TEE) respectively.These four methods were compared with each other.The correlation between 3D-TEE measures and other three methods were analyzed.Results The AAD measured by 2D-TTE,2DTEE,Bip-TEE and 3D-TEE were (22.02±2.21)mm,(23.34±2.34)mm,(23.89±2.37)mm,(24.21±2.78)mm,respectively.The differences among 4 groups was significant (F=3.88,P=0.01).No statistically significant differences were found between Bip-TEE and 3D-TEE,2D-TEE and 3DTEE,Bip TEE and 2D-TEE (all P＞0.05).There were significant differences between 2D-TTE and 2D-TEE,2D-TTE and Bip-TEE,2D-TTE and 3D-TEE (all P＜0.05).The AAD measured by 3D-TEE were positively correlated with that of 2D-TTE,2D-TEE,Bip-TE (r=0.79,0.88,0.94,all P＜0.05).Conclusion Bip-TEE is a feasible method to measure the AAD rapidly and can provide reliable measurements for the prosthetic valve size in TAVI.

Emerging evidence has indicated that BRCC 36-mediated K63-linked ubiquitination modification was involved in diverse cellular functions , including endocytosis , apoptosis and DNA damage repair .We previously showed that activation of cGMP/PKG pathway con-tributed to the binding of BRCC36 and the pro-fibrotic factor Smad3.The current study tested the hypothesis that BRCC 36 functions as a negative regulator of transforming growth factor-beta ( TGF-β)/Smad3 pathway and participates in cardiac remodeling .In isolated adult mouse cardiac fibroblasts , we have demonstrated that TGF-β1 treatment significantly increased the expression of BRCC 36.Over-expression BRCC36 suppressed TGF-β1-induced Smad3 phosphorylation, nuclear translocation, extracellular matrix molecular expres-sion and cell proliferation .On the contrary, silencing BRCC36 by transfection of adenovirus-carrying BRCC36 shRNA potentiated to
enhance the pro-fibrotic effect of TGF-β.In vivo, under chronic pressure overload condition-induced by transverse aortic constriction , myocardial pro-survival protein Bcl-2 and Mcl-1 expression were significantly decreased and the pro-apoptosis protein Puma was in-creased.However, the cardiac-specific over-expression of BRCC36 significantly increased myocardial Bcl-2 and Mcl-1 and inhibited Puma expression .Interestingly , we also found that sustained pressure overload resulted in a significant myocardial DNA injury in wild type mice, which was characterized by the increase of γH2AX level.However, cardiac-specific BRCC36 over-expression significantly decreased the level of γH2AX in the pressure overloaded heart in the transgenic mice , while effectively enhanced myocardial RAD 51 expression, a marker of DNA damage repair.Furthermore, BRCC36 over-expression effectively attenuated TAC-induced cardiac fibro-sis and remodeling in the transgenic mice , compared with the wild type mice .Collectively , the results have suggested that BRCC 36 ef-fectively protected heart against chronic pressure overload-induced cardiac remodeling though antagonizing TGF-β/Smad3 pathway and enhancing myocardial DNA injury repair response .

Objective To assess the risk factors of the in-hospital mortality of acute type A aortic dissection after operation. Method From January 2003 to June 2008,185 patients, 144 males and 41 females, with acute type A aortic dissection operated on were enrolled. The average age of patients was (49.46 ± 11.04 ) years old.The patients' demographics, history, clinical features, and some laboratory examinations were reviewed. Univariate and multivariate analysis followed by logistic regression analysis were carried out to identify the predictors of inhospital mortality. Results The in-hospital mortality rate was 9.1%. The results of univariate and multivariate analyses as follows: pre-operation positive neurological symptom (Univariate OR = 5.084,95%CI:1.792 -14.426, P = 0.002; Multivariate OR = 5.538,95%CI: 1.834 - 16.721, P = 0.002, respectively), hypotension (Univariate OR = 6.986,95%CI:1.510- 32.323,P =0.013; multivariate OR = 1.998,95%CI:0.315-12.679,P = 0.463, respectively) and renal failure (Univariate OR = 3.594,95%CI:1.237 - 10.438,P =0.019; Multivariate OR = 3.254,95%CI:1.034- 10.242, P= 0.044, respectively). Conclusions There are two predictors, pre-operation positive neurological symptom and renal failure, of pre-hospital mortality found in current analyses. Our results may improve the regimen made by cardiac surgeons and emergency doctors so as to help patients and their relatives to make correct decision.