Table of Content

21 June 2015, Volume 36 Issue 3

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Progress in anti-fibrosis treatment of chronic kidney disease

Zhang Dongliang

2015, 36(3):  333-337.  doi:10.3969/j.issn.1006-7795.2015.03.001

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Chronic kidney disease (CKD) is one of the most serious diseases of human being. A lot of researches on the kidney fibrosis, which plays the core role in the progression of CKD, have been conducted recently. Many studies' results indicated that different cells of kidney have different effects on tissue fibrosis and regeneration. Different subgroup of inflammatory cells may actively support the regeneration process. According to these researches, many new methods were developed to treat the kidney fibrosis, including anti-transforming growth factor-β (TGF-β) treatment, anti-oxidative stress, anti-vascular calcification, and anti-chemokines treatments. Mesenchymal stem cells or other cells have been tested for treatment of kidney fibrosis. It will be possible to inhibit, stop, or even reverse kidney fibrosis in the future.

Aortic arch reconstruction for acute type A aortic dissection

Sun Lizhong, Rong Tianhua

2015, 36(3):  338-344.  doi:10.3969/j.issn.1006-7795.2015.03.002

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Acute type A aortic dissection involving the aortic arch remains an inherently lethal medical condition ever since it is known to us. Prompt diagnosis and proper treatment is urgently needed and supposed to significantly lower the mortality rate. Although open surgical repair is undoubtedly the mainstream technique now, high rate of postoperative mortality and morbidity has always been a formidable challenge. Along with the rapid development of the aortic surgery and cognition of the disease, a variety of approaches have been invented or introduced, mostly aiming at simplifying procedure, minimizing surgical trauma and improving prognoses at the same time. Apart from the conventional surgical operation, recently emerged Sun's procedure, open branched stent graft placement, hybrid procedure, and even the endovascular repair have been taken into consideration. However, the more choices we have, the more we come to realize that ideal techniques with the characteristics of stability, convenience, riskless, effectiveness and wide applicability remain to be pursued. Because of the complexity of aortic arch in aspects of anatomy, function and pathological changes, the appropriate approach for patients with type A dissection involving the aortic arch remains controversial. This article provides current information about strategies of aortic arch reconstruction used for acute type A aortic dissection by reviewing related publications as well as brief discussions.

Comparative study on effect of surgery for moderate/severe ischemic mitral regurgitation

Yin Bo, Wang Xiaolong, Liu Yuyong, Zheng Tie, Gong Ming, Li Haiyang, Liu Ou, Guan Xinliang, Peng Xiaole, Jiang Wenjian, Huang Qi, Guo Dong, Zhang Hongjia

2015, 36(3):  345-353.  doi:10.3969/j.issn.1006-7795.2015.03.003

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Objective This study aimed to compare effects of surgeries for mitral valve repair and replacement in patients with ischemic mitral regurgitation (IMR), and to determine whether mitral valve operation in different ways will have an impact on patient mortality, survival rate and prognosis. Methods This study included a total of 296 patients, all had moderate to severe chronic ischemic mitral regurgitation.The patients were divided into two groups; on the basis of coronary artery bypass grafting, group 1 received mitral valve repair and group 2 received mitral valve replacement. The patients were followed up for the long term survival rate and heart function, readmission. Finally, the data were analyzed through statistical method. Results 1) No statistically significant differences in baseline data were found between the two groups of patients, and operation details; 2)The operation mortality: No significant difference was found between mitral valve repair group and mitral replacement group (P=0.607);3) Long term survival curve: mitral valve replacement was better than mitral valve repair on the whole (P <0.05); survival rate of mitral valve replacement group patients was better than that of mitral valve repair group when left ventricular ejection fraction was over 30% (P <0.05); survival rate of patients received mitral valve replacement was better than that of patients received mitral valve repair when age was over 65 years (P <0.05); no significant difference was found between mitral valve replacement and mitral valve repair groups in survival rate when left ventricular ejection fraction was less than 30% (P >0.05). 4) In the postoperative ICU, residence time, total hospital stay and cost were significantly better in mitral valve repair group. 5)Echocardiography showed that regurgitation corrective effect was significantly better in mitral valve replacement group than that of the mitral valve repair group. 6)In the rehospitalization rate, no statistically significant differences was found between the two groups. 7)Follow up of heart function in patients after operation, no significant difference was found between two groups. Conclusion 1) For the effect of correction of regurgitation, mitral valve replacement was superior to repair. 2) Operation mortality was not significantly different between two groups. The long-term survival rate of the replacement group was superior to the repair group. 3) To get better prognosis, method of surgery should be chosen based on patients' condition: when left ventricular ejection fraction is over 30%, mitral valve replacement is advised; when patient's age is over 65 years, replacement is advised; when left ventricular ejection fraction is over 30%, either method is good; If patient is young, considering the long-term anticoagulation problems, mitral valve repair is better.

Anatomic data and clinical significance of aortic arch with type A aortic dissection in China: single center experience

Yao Peng, Pan Xudong, Qiao Huanyu, Liu Ningning, Xue Jinrong, Bai Tao, Liu Yongmin

2015, 36(3):  354-359.  doi:10.3969/j.issn.1006-7795.2015.03.004

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Objective To provide basic data references of aortic arch and its branch vessels for selection of artificial implants (four branches aortic graft, branch stent graft) used in total aortic arch replacement procedure of acute aortic dissection through the method of measuring relevant parameters such as branch vessels' diameters, intervals and angles by multiple detector CT (MDCT) angiography. Methods MDCTA imaging data of continuous 420 patients with Stanford type A aortic dissection in our center from February 2009 to May 2014 were collected, and the diameters of the aortic arch and its branch vessels, intervals and angles in three-dimensional images were measured. Results 1The type of the aortic arch and its branches: standard 96.5% (405/420) and variant 3.5% (5/420);2Standard aortic arch inner diameter was (36.6±5.06) mm (95%CI: 36.11-37.09 mm); 3The standard inner diameters of aortic branch vessels: innominate artery(IA) (16.20±3.44) mm (95%CI: 15.86-16.54 mm), left common carotid artery(LCCA) (10.90±2.03) mm (95%CI: 10.7-11.1 mm) and left subclavian artery(LSA) (12.53±2.50) mm (95%CI: 12.29-12.77 mm); the difference of IA diameter according to whether IA was involved by aortic dissection was statistically significant, while which of LCCA and LSA were not statistically significant; 4The standard type of the aortic arch branch vessels' intervals: IA-LCCA interval was (18.68±4.21)mm (95%CI: 18.27-19.09 mm) and LCCA-LSA interval was (17.80±3.38)mm (95%CI: 17.47-18.13 mm); and these intervals were not statistically different whether aortic arch was expanded or not. IA-right subclavian artery(RSA) interval was (38.59±5.16)mm (95% CI: 38.09-39.09 mm) and LSA-left vertebral artery(LVA) was (38.57±7.91)mm (95%CI: 37.8-39.34 mm), these intervals were not significantly different whether the branch vessels were involved by aortic dissection or not; there was not a single case of IA-RSA interval was <20 mm; and LSA-LVA interval of 99% cases was >20 mm; 5The included angles between standard type of aortic arch trunk and branch vessels were IA (44.43±14.83)° (95% CI: 42.99°-45.87°), LCCA (50.30±11.40)° (95% CI: 49.19°-51.41°) and LSA (11.40±15.04)°(95% CI: 51.16°-54.08°) respectively; There were no statistically significant difference whether aortic arch branches was involved or not. Conclusion Our study published all the parameters of aortic arch and its branch vessels in type A dissection in China, providing data references for selection of artificial implants in total aortic arch replacement procedure in aortic dissection, such as four branches aortic graft、branch stent graft, especially branch stent-woven-graft.

Anticoagulation therapy during pregnancy in patients with prosthetic heart valves

Wang Jun, Lyu Yingxin, Zhang Haibo

2015, 36(3):  360-363.  doi:10.3969/j.issn.1006-7795.2015.03.005

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Anticoagulation therapy during pregnancy is critical to both mother with prosthetic heart valves and fetus. Warfarin offers the best maternal protection against thrombosis, but it might be associated with a high risk of fetal malformations and pregnancy loss. Heparin derivatives are associated with a reduced risk of fetal damage, but an increased risk of valve thrombosis in the mother. The risk of warfarin-related embryopathy might be dose-related.The use of warfarin throughout pregnancy for those patients at the greatest risk of thromboembolism is feasible.And the patient's preferences should also be take into account.

Effects of temperature gradient classification on perioperative cerebral protection in Stanford A aortic dissection

Peng Xiaole, Wang Xiaolong, Liu Yuyong, Gong Ming, Li Haiyang, Guan Xinliang, Guo Dong, Huang Qi, Zhang Hongjia

2015, 36(3):  364-370.  doi:10.3969/j.issn.1006-7795.2015.03.006

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Objective Perioperative brain damage is the common complication of the aortic operation undergoing hypothermic circulatory arrest, and has no important influence on recovery after operation and long-term quality of life. This study evaluates whether temperature-control induces the cerebral protection in hypothermic circulatory arrest. Methods We enrolled 66 patients who suffered from Stanford A type aortic dissection and underwent aortic arch replacement with stented elephant trunk. The concentration of serum neuron specific enolase (NSE) and S-100 protein was measured before operation, during circulatory arrest, rewarming to 36 ℃, 4 hr and 24 hr postoperation. The nerve function and cognitive function was assessed before surgery and 7 days after operation according to Chinese nervous Function Severity Score (CSS) and Mini-Mental Status Examination (MMSE). Patients were divided into three groups on the basis of nasopharyngeal temperature during circulatory arrest (group Ⅰ: 18-20 ℃, II:20.1-23 ℃, Ⅲ:20.1-23 ℃). The data were analyzed by the software SPSS 19.0. Results There were no significant differences in the gender, age, weight, lesion location, preoperative cardiac function, aortic root and ascending aorta diameter among the three groups. No significant difference was observed in the operation method, circulatory arrest time, cross clamping time, CPB time and operation time between the three groups. There was no significant difference in the CSS score, MMSE score, serum NSE concentration, S-100 protein concentration in patients among three groups before operation. In three groups, there was no significant difference in the postoperative CSS score and MMSE score. The concentration of serum NSE and S-100 protein was not significant different at each time point preoperatively or postoperatively. The logistic analysis showed that cardiopulmonary bypass time was an independent risk factors for postoperative cognitive dysfunction. ConclusionThe temperature difference has no effect on the degree of brain injury when we controlled the temperature of circulatory arrest at 18 ℃-25 ℃ and maintain the brain oxygen supply by antegrade selective cerebral perfusion. The use of cardiopulmonary bypass was the major contributor to post operative cognitive dysfunction(POCD). Involving the aortic arch operation, it is feasible and safe in the theory to increase the circulatory arrest temperature to 25 ℃.

Effect of minimally invasive surgery on left atrial function in atrial fibrillation patients

Zhang Zhenhua, Zhang Haibo, Han Jiancheng, Meng Xu, Han Jie, Li Yan, Wang Gang

2015, 36(3):  371-375.  doi:10.3969/j.issn.1006-7795.2015.03.007

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Objective To compare the left atrial function in paroxysmal atrial fibrillation patients before and after undergoing minimally invasive surgery. Methods Consecutive 52 patients with paroxysmal atrial fibrillation who underwent minimally invasive surgery (pulmonary vein isolation, left atrial appendage excision, ligament of Marshall resection) in Anzhen Hospital from October 2012 to June 2014 were enrolled into this study. Left atrial function was measured by real-time three-dimensional echocardiography before operation, 7 days and 3 months after operation. Results 1) Each of the 52 patients successfully underwent the surgery. Neither serious complications related to the operation happened nor embolism events occurred within the 3-month follow-up period. Apart from 6 recurrence, 88.5% (46/52) patients were free of atrial fibrillation. The left atrial appendage of 77% (40/52) patients were successfully excised(left atrial appendage stump <1 cm). 2) Postoperative left atrial maximum volume (LAVmax) was gradually decreased compared to preoperative value (P <0.001), and left atrial minimum volume (LAVmin) detected at postoperative 3 months was decreased as compared with postoperative 7 days and preoperative values respectively (P <0.001). Left atrial emptying fraction (LAEF), as an indicator for storage function, displayed a lower level at postoperative 7 days (P <0.001), but the difference between preoperative and postoperative 3 months was not statistically significant(P=0.235). Left atrial passive ejection fraction (LAPEF) indicating atrial transmission function detected at postoperative 7 days and 3 months both were decreased as compared with preoperative values (P <0.05), but the difference between postoperative 7 days and 3 months was not statistically significant (P=0.052). Left atrial active ejection fraction (LAAEF) indicating atrial pumping function detected at postoperative 3 months was higher than postoperative 7 days and preoperative values. And the value for postoperative 7 days was lower than preoperative value (P <0.05). The peak velocity of A wave detected at postoperative 3 months was higher than that at postoperative 7 days (P <0.05), but the difference between postoperative 3 months and preoperative was not statistically significant (P=0.497). Conclusion 1Minimally invasive surgery can be used as an effective treatment for paroxysmal atrial fibrillation patients to restore sinus rhythm and prevent embolism events. 2We will benefit in strengthening atrial function and reverse remodeling from this operation. Further follow-up studies are warranted to provide a more definite explanation about the effect of minimally invasive surgery on atrial function on our observation.

Management of acute type A aortic dissection complicated with lower limb ischemia

Rong Tianhua, Liu Yongmin, Zhu Junming, Ma Weiguo, Zhang Wei, Wang Longfei, Zhao Honglei, Pan Xudong, Sun Lizhong

2015, 36(3):  376-381.  doi:10.3969/j.issn.1006-7795.2015.03.008

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Objective To explore the effect of Sun's procedure for type A acute aortic dissection complicated with lower limb ischemia. Methods From July 2009 to January 2014, 27 consecutive patients were diagnosed as type A acute aortic dissection complicated with lower limb ischemia and underwent total arch replacement using a tetrafurcated graft with stented elephant trunk implantation(Sun's procedure). There were 23 males and 3 females with an average age of (48.1±7.9)years. Concomitant proximal procedures included: aortic valve repair plus ascending aorta replacement in 7 patients, ascending aorta replacement alone in 10 patients, Bentall procedure in 8 patients and modified David procedure in 1 patient. Other concomitant procedures were: CABG in 2 patients, ascending aortic-femoral arterial bypass in 5 patients and femoral-femoral arterial bypass in 2 patients. Results Average extracorporeal circulation time was(209±61)min, average aortic cross-clamp time was(119±38)min, and the average circulatory arrest time was(27±11)min. Early mortality rate was 14.8%(4/27)and the morbidity rate was 55.6%(15/27). Mean time of follow-up was(41±27)month with a follow-up rate of 87.0%(20/23). One patient died of cerebrovascular event. No aortic related death occurred. One patient received secondary femoral-femoral artery bypass one month after Sun's procedure and recovered well. The overall lower limb ischemia recovery rate of operation survivors was 90.9%(20/22). Conclusion Sun's procedure is safe, feasible and effective for type A acute aortic dissection complicated with lower limb ischemia. Concomitant or secondary bypass procedures are also possible to restore distal perfusion when necessary. Comprehensive evaluation of patient's status is strongly recommended for optimal surgical decision making.

Anesthetic complications and related treatment after cardiac surgery

Qiu Yinyan, Jin Xiufeng, Xu Shangdong

2015, 36(3):  382-387.  doi:10.3969/j.issn.1006-7795.2015.03.009

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With the development of the social economy and the improvement of people's living standard, the incidence of cardiovascular disease increased year by year, becoming the main disease that affect the health of our people. Due to the complexity and diversity of cardiac surgery, anesthesiologists are now confronting an overwhelming challenge. Not only because most patients with heart disease are associated with cardiac dysfunction, heart failure or other chronic diseases, but also because the operation of cardiac surgery and the use of cardiopulmonary bypass that lead to the increasing morbidity of anesthetic complications after cardiac surgery, greater demands are accordingly being placed on the anesthesiologists. Anesthetic complications are defined as damage or consequences directly caused by narcotic drugs, types of anesthesia, equipment and management of anesthesia, not including primary diseases. In this paper, anesthetic complications after cardiac surgery were systematically classified, and the principles of corresponding treatment as well as the prevention were analyzed and put forward, to make a summary of guidance about anesthetic complications after cardiac surgery.

Predictive factors of acute ST-segment elevation myocardial infarction patients with spontaneous reperfusion

Wang Jun, Hua Qi, Li Xiaoming, Xue Song, Wang Yunfei, Wang Li, Fan Zhenxing, Kong Qiang, Wang Yanling, Li Jing

2015, 36(3):  388-392.  doi:10.3969/j.issn.1006-7795.2015.03.010

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Objective To explore the clinical implications of different evaluation methods and value for the prediction of spontaneous reperfusion in ST-segment elevation myocardial infarction (STEMI). Methods A total of 260 patients who underwent coronary angiography (CAG) were enrolled. The patients were divided into spontaneous reperfusion (SR, TIMI flow grade 3 identified by CAG) group (n=67) and nonspontaneous reperfusion (NSR, TIMI flow grade 0-2 identified by CAG) group (n=193). We analyzed the predictive value of ST-segment resolution (STR), hemoglobin (Hb), and high-sensitivity C-reactive protein (hsCRP) in SR in acute myocardial infarction (AMI). Results There was significant difference in ST-segment resolution, symptoms release, Hb, creatinine, uric acid, MB isoenzyme of creatine kinases, and hsCRP between two groups. In Logistic regression model, Hb (OR=1.064,95%CI:1.036-1.094,P=0.000), hsCRP (OR=0.811,95%CI:0.713-0.923,P=0.001) and STR>50% (OR=3.638,95%CI:1.793-7.318,P=0.000) were independent predictors for SR. The receiver-operating characteristic curve (ROC) analysis for Hb, hsCRP, and STR combined in predicting spontaneous reperfusion showed sensitivity of 80.6%, specificity of 63.7%, and area under the curve (AUC)=0.78(0.72-0.85). Conclusion Hb, hsCRP and STR have predictive value for SR.

Impact of late-phase of limb ischemia preconditioning on prognosis of patients with percutaneous coronary intervention

Wang Yanling, Hua Qi, Liu Zhi, Chu Yanyan

2015, 36(3):  393-398.  doi:10.3969/j.issn.1006-7795.2015.03.011

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Objective To assess whether late-phase limb ischemia preconditioning (L-LIP) is effective in myocardial protection in patients with coronary heart disease undergoing elective percutaneous coronary intervention (PCI) and improve the prognosis at 6 months after PCI. Methods A total of 200 patients planned to PCI treatment admitted into our hospital from January 2010 to December 2013 were enrolled and divided randomly into L-LIP (98 patients) (induced by three 5-minute inflations of a blood pressure cuff to 200 mmHg around the upper arm, followed by 5-min intervals of reperfusion) or control (102 patients) at 24 h before PCI. Data of PCI, creatine phosphokinase (CK), its cardiac isoenzyme (CK-MB), troponin I (TnI), and high-sensitivity C-reactive protein (hs-CRP) levels were measured at 24 h after PCI. Adverse events' rates at 6 months were assessed. Results Patients in L-LIP group had significantly lower incidences of Chest pain score >1 and ECG ST deviation> 1 mm (P <0.05). The median TnI, CK, and CK-MB concentrations at 24 h were lower in the L-RIPC group (0.009 vs 0.036 ng/mL, 123 vs 186 IU/L, 15 vs 27 IU/L; P <0.05). Excluding patient with side branch occlusion, cTnI, CK, and CK-MB were also lower in the L-LIP group (0.008 vs 0.040 ng/mL, 126 vs 191 IU/L, 16 vs 28 IU/L; P <0.05). Kaplan-Meier plots demonstrated a significant decrease in adverse events' rate in L-LIP group (χ²=4.374, P=0.036). Conclusion L-LIP is effective in myocardial protection in patients undergoing elective PCI and reduces adverse events' rate at 6 months.

Discussion of the relationships between PVC-burden with electrocardiography and heart function parameters in patients with premature ventricular contractions

Luo Hongyu, Hua Qi, Liu Jianfeng, Zhu Weiwei

2015, 36(3):  399-404.  doi:10.3969/j.issn.1006-7795.2015.03.012

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Objective To study the relationships between premature ventricular contractions (PVCs) burden with the QRS duration, correct QT interval by Bazett (QTCB) on the ECG and heart function parameters in patients with frequent PVCs. Methods Retrospective analyzed 110 patients with frequent PVCs. All the patients were divided into 3 groups by the burden of PVCs: the lower burden group(< 10%,n=25), the medium burden group(10%-20%,n=54), the higher burden group(> 20%,n=31); and selected another 34 patients without PVCs as control group. The relationships between PVCs burden with electrocardiography and heart function were analyzed. Results Compared with the control group, the QRS duration, QTCB and left ventricular myocardial mass index (LVMI) were increased (P <0.01). The equation of liner regression is Y=0.047X₁+0.088 X₂-12.038,F=7.977,P=0.000,the standardized coefficients is QTCB=0.290, QRS duration=0.193.Conclusion The QRS duration, QTCB, and LVMI increased with PVCs burden's increase, and QTCB had a greater impact on PVCs burden.

Relationship of left atrial diameter with the red blood cell distribution width in patients with primary hypertension

Li Jing, Hua Qi, Liu Jianfeng, Luo Hongyu, Zhu Weiwei

2015, 36(3):  405-409.  doi:10.3969/j.issn.1006-7795.2015.03.013

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Objective To investigate the relationship between left atrial diameter (LAD) and the red blood cell distribution width (RDW) in patients with primary hypertension. Methods Overall 580 patients with essential hypertension were enrolled into our study. All patients were divided into LAD enlarged group (LAD≥40 mm, 196 cases) and non-LAD enlarged group (LAD< 40 mm, 384 cases). Results The age, pulse pressure, body mass index and left ventricular mass index in LAD enlarged group were significantly higher, but the level of left ventricular ejection fraction and cardiac output were lower than those in non-LAD enlarged group. The difference was statistically significant (P <0.05). Multiple linear regression analysis results showed that age, pulse pressure, body mass index, left ventricular mass index and RDW had a linear positive correlation with LAD. Multivariate logistic regression analysis showed that RDW was an independent predictor for the patients primary hypertension with LAD enlargement (OR=1.269,95%CI:1.018-1.582,P=0.034). Conclusion In primary hypertension patients, LAD is correlated with the level of RDW. RDW is an independent predictor for primary hypertension with LAD enlargement.

Analysis on pharmacotherapy for hospitalized patients with acute heart failure——a multicenter cross-sectional study

Yang Jing, Hua Qi, Li Jing, Tan Jing

2015, 36(3):  410-413.  doi:10.3969/j.issn.1006-7795.2015.03.014

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Objective To understand the clinical pharmacotherapy of hospitalized patients with acute heart failure. Methods A total of 203 consecutive cases hospitalized for acute heart failure were enrolled into this study. The patients, personal information, drug usage were collected and analyzed. Results In the patients with acute heart failure caused by acute myocardial infarction (AMI) and non-AMI, the total utilization of diuretics were 72.6% and 83.3%, respectively; the total utilization rates of intravenous vasodilators were 91.6% and 95.4%, majority was nitroglycerin; the total utilization of oral vasodilator was 93.7% and 86.1%. The total utilization of positive inotropic agents were 28.4% and 49.1%, of which digoxin utilization rates were 3.2% and 25.0%, and the difference was statistically significant. The total utilization rates of angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) were 85.3%, 71.3%, and the difference was statistically significant. The total utilization rates of β-blockers were 48.4% and 56.5%. Conclusion Drug treatment of acute heart failure with traditional diuretic and vasodilator therapy in hospitalized patients, is still widely used, but the use of positive inotropic agents is relatively cautious, especially in heart failure patients caused by AMI, the proportion of using digitalis inotropic drugs is very low. ACEI/ARB had a better application in hospitalized patients, but there is still room for improvement. The rate of β-blocker use is not high, clinicians need to pay further attention to proper pharmacotherapy of acute heart failure.

Flow cytometry for assessing circulating platelet activation and platelet-leukocyte adhesion

Cui Wei, Liu Sa, Dong Lei, Yuan Hui, Yang Ping, Wu Yina, Li Yulin

2015, 36(3):  414-419.  doi:10.3969/j.issn.1006-7795.2015.03.015

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Objective To assess the circulating platelet activation and platelet leukocyte adhesion by flow cytometry and lay the foundation for the clinical development of platelet associated diseases. Methods The sodium citrate anti-coagulation blood was collected from 50 cases of healthy volunteers, using CD61/PAC-1/CD62P to detect platelet activation; analysis the percentage of early activation (PAC-1⁺CD62P^-) and late activation (PAC-1⁺CD62P⁺). Moreover, the different time points, such as 0 min, 5 min, 10 min, 15 min, 20 min, 30 min, and 60 min were detected the platelet activation. Via CD61/CD3/CD19/CD11b/CD14/CD45 detected platelet activation, and analyzed the percentages of platelet leukocyte adhesion (CD45⁺CD61⁺), platelet-T lymphocyte adhesion (CD3⁺CD61⁺), platelet-B lymphocyte adhesion (CD19⁺CD61⁺), platelet monocyte adhesion (CD14⁺CD61⁺), platelet-neutrophil adhesion(CD45^low+CD11b⁺ CD61⁺). Results The time point of 15 minutes was detected to establish the reference range for healthy human platelet activation : the percentage of early activation was 3.75 (1.00-9.80) %, late activation was 0.10 (0.00-0.10) %. Detected the percentages of platelet leukocyte adhesion, platelet-T lymphocyte adhesion, platelet-B lymphocyte adhesion, platelet-monocyte adhesion and platelet-neutrophil adhesion showed platelet-monocyte adhesion was the highest proportion (10.75 ± 3.23)%. ConclusionStorage time of blood samples should not exceed 15 min to detect platelet activation. Platelet-monocyte adhesion was the key role in platelet activation analysis. Establishment the fast, stable, accurate evaluation method of platelet activation is important.

Effects of Xiaoshuan enteric-coated capsule on neuronal damage by eliminating β-amyloid protein in thalamus of MCAO rats

Zhang Ning, Wu Xi, Wang Shuo, Wang Lei, Zhang Qiuxia, Zhao Hui, Wang Yali

2015, 36(3):  420-425.  doi:10.3969/j.issn.1006-7795.2015.03.016

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Objective To investigate the effects of Xiaoshuan enteric-coated capsule on neuronal damage and the expression of cystein-aspartate protease-3 (Caspase-3), amyloid precursor protein (APP) and β- amyloid protein (Aβ) in thalamus of middle cerebral artery occlusion(MCAO)rats. Methods The animal model of middle cerebral artery occlusion(MCAO)were adopted. Xiaoshuan enteric-coated capsule(420、140、47 mg·kg^-1) was given orally to rats once each day for 15 days after ischemia. The expression of Caspase-3 was detected by using immunofluorescence and APP, Aβ42 were detected by using immunohistochemistry at 15d after ischemia. Results Compared with control rats, the number of neurons was reduced and the number of Caspase-3 was added, the expression of APP and Aβ42 was increased in MCAO rats(P <0.01); The number of neurons was added and the number of Caspase-3 was reduced, the expression of APP and Aβ42 was decreased in Xiaoshuan enteric-coated capsule rats to compared with the model group(P <0.05). Conclusion Xiaoshuan enteric-coated capsule increased the number of neurons, reduced the number of Caspase-3 and decreased the expression of APP and Aβ42. As a result, Xiaoshuan enteric-coated capsule can protect the thalamus of ischemia.

The localization of dopamine receptors on the nitrergic neurons in gastric myenteric plexus of rats

Fan Ruifang, Zheng Lifei, Feng Xiaoyan, Zhang Xiaoli, Zhang Yue, Zhu Jinxia

2015, 36(3):  426-431.  doi:10.3969/j.issn.1006-7795.2015.03.017

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Objective To investigate the distribution of dopamine receptors in neural nitric oxide synthase (nNOS)immunoreactive neurons in myenteric plexus of gastric corpus. Methods Immunofluorescence for frozen sections of gastric corpus and whole mount stretched preparation of myenteric plexus were used to investigate the colocolization of dopamine receptors and nNOS in myenteric neurons. Results The immunoreactivities of five subtypes' dopamine receptors and nNOS were largely distributed in the enteric neurons of gastric myenteric plexus. Furthermore, the Immunofluorescence of dopamine receptor D₁, D₂, D₃ and D₅, but not D₄ were observed in the nNOS-immunoreactive neurons. Conclusion Dopamine receptor D₁, D₂, D₃ and D₅ were distributed in the gastric nitrergic neurons of gastric corpus, which might be involved in the NO synthesis, and then regulation of gastric motility.

Distribution of dopamine receptors in gastric mucosal somatostatin-secreting cell of human and mice

Sun Lu, Feng Xiaoyan, Zheng Lifei, Zhang Xiaoli, Zhang Yue, Zhu Jinxia

2015, 36(3):  432-436.  doi:10.3969/j.issn.1006-7795.2015.03.018

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Objective To investigate the distribution of dopamine D₁, D₂ receptors in somatostatin-secreting D cells in gastric corpus mucosa in human and mice. Methods Immunofluorescence was used to detect the expression of dopamine receptors on the somatostatin-secreting D cells in human or mice gastric corpus. Results Abundant immunofluorescence reactivities (IR) of dopamine D₁ and D₂ receptors, and somatostatin-IR cells were distributed in the gastric corpus mucosa. Furthermore, D₂ receptors-IR, not D₁ receptors-IR, was observed in the somatostatin-IR cells of mice and human gastric corpus mucosa. Conclusion Dopamine D₂ receptors, not D₁ receptors were distributed in the gastric somatostatin-secreting D cells of both human and mice, which might mediate the regulation of dopamine on the somatostatin secretion, gastric secretion and motility.

Pathological analysis of liver in fatal influenza A (H1N1) virus infected cases

Wang Jue, Dai Jie, Wang Daye, Lyu Fudong, Hu Zijing, Jin Ronghua, Qi Jing, Duan Xuejing

2015, 36(3):  437-440.  doi:10.3969/j.issn.1006-7795.2015.03.019

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Objective In this study, we observed the pathological characteristics of liver after influenza A (H1N1) virus infection, studied the expression of hemagglutinin (HA),nucleoprotein (NP),CD68 as well as the transforming growth factor β₁ (TGF-β₁) in the livers in the death cases, trying to discover the potential pathogenesis of the fatal H1N1. Methods Eight cases of fatal human influenza A (H1N1) infection, including 2 autopsy and 6 paramortem needle puncture biopsies were enrolled into the study. Histologic examination, special stain and immunohistochemical assays were carried out. Results In the hepatic cells band-like necrosis appeared. Micro-bubbled fatty change was observed in the hepatic cells of the pregnant women. Immunohistochemical study demonstrated the presence of nuclear protein(NP) and hemagglutinin (HA) virus antigens in macrophages. CD68 was positively expressed in hepatic kuffer' cells. TGF-β was positively expressed in macrophages and the expression rate was significantly higher than that of controls in zone of necrosis. Conclusion The study indicated that the pathological changes of influenza A (H1N1) virus infected patients were not limited to the respiratory tract, the liver was another target. Its mechanism might be related to the role of CD68 and TGF-β in the course of the disease.

Effects of Winged Euonymus Twig on serum leptin in rats

Sun Ruixi, Wan Maoting, Guo Jian, Peng Jing, Huang Heqing, Li Ling

2015, 36(3):  441-443.  doi:10.3969/j.issn.1006-7795.2015.03.020

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Objective To investigate the effects of Winged Euonymus Twig in the level of serum leptin and weights of high fat rats. Methods Totally 38 male wistar rats were randomly divided into blank control group(fed with ordinary diet), high fat diet group and 3 treatment groups(high dose, middle dose and low dose). High fat diet rats were treated with different dosage Winged Euonymus Twig for 4 weeks, observed the changes of body weight and serum leptin. Results The body weight and levels of serum leptin of high fat diet rats were all higher than those in the normal rats,after treated with Winged Euonymus Twig, the body weight of high dose and middle dose group were obviously decreased(P <0.01,P <0.05) and the levels of serum leptin were markedly higher(P <0.05). Conclusion Winged Euonymus Twig can increase the levels of serum leptin and decrease the body weight, this conclusion may prove that Winged Euonymus Twig can adjust glucolipid metabolism, thus provided experimental foundation for the clinical application of the plant to the patient with diabetes and hyperlipemia.

Detection of vancomycin-resistant enterococcus faecium by MALDI-TOF MS

Wu Wei, Wang Lijun, Sui Wenjun, Zhang Gui

2015, 36(3):  444-448.  doi:10.3969/j.issn.1006-7795.2015.03.021

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Objective To evaluate a rapid matrix-assisted laser desorption ionization-time of flight mass spectrometry (MAIDI-TOF MS) assay in identifying vancomycin-resistant Enterococcus faecium. Methods Totally 150 enterococcus faecium clinical strains collected from 2009 to 2012 were studied, including 60 vancomycin-resistant enterococcus faecium (VRE) isolates and 90 vancomycin-susceptible (VSE) strains. Resistance genes were detected by gene sequencing. Spectra of 30 VRE and 30 VSE which were randomly chosen, were analyzed by ClinPro Tools program of MALDI-TOF MS in order to screen the discrepancy mass peaks according to ROC curve. 30 VRE and 60 VSE were detected by MALDI-TOF MS according to the discrepancy mass peaks. Results All strains were verified as enterococcus faecium by MALDI-TOF MS. 60 VRE strains carried vanA gene, and 90 VSE strains carried no vancomycin resistant gene. Two discrepancy mass peaks between the two groups of strains were 3516.14, 3644.12, of which AUC were 0.782, 0.767, respectively. Through the two discrepancy mass peaks, performance of VRE detection method by MALDI-TOF MS were below. Sensitivity=80%, specificity=90%, false positive rate=10%, false negative rate=10%, positive predictive value=80%, negative predictive value=90%. Conclusion MALDI-TOF MS can be used accurately to identify VRE, and guide the clinical rational use of antibiotics.

Clinical studies on individual therapy for acute suppurative cholangitis in aged patients

Song Yong, Huang Yachuan, Qin Gaoping

2015, 36(3):  449-453.  doi:10.3969/j.issn.1006-7795.2015.03.022

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Objective To compare endoscopic retrograde cholangio-pancreatography (ERCP) + endoscopic sphincterotomy (EST) + endoscopic nasobiliary drainage (ENBD) and percutaneous transhepatic cholangial drainage (PTCD) operation for acute obstructive suppurative cholangitis (AOSC) in aged patients with the treatment effect, and provide the basis for the treatment of AOSC operation mode selection. Methods Retrospective analysis of 93 patients with acute obstructive suppurative cholangitis in patients with clinical data of our hospital from December 2009 to January 2014, including ERCP+EST+ENBD (A group) 42 cases, PTCD 51 cases (B group), compared with the 2 methods of treatment effect.Results Totally 93 cases had successful intervention and endoscopic therapy, PTCD tolerance better drainage effect more precisely, ERCP+EST+ENBD provides a solution of calculus of bile duct obstruction cases in control of damage is minimized under the premise. Conclusion PTCD for the treatment of AOSC, the success rate is high, the drainage effect is reliable, can fully reduce the pressure of biliary tract, reduce clinical risk, creating opportunities and conditions for the two stage surgical treatment, but the ERCP+EST+ENBD in minimally invasive premise provides a solution for biliary calculi obstruction.

A retrospective analysis of post-craniotomy intracranial infection in pediatric patients with supratentorial neurosurgical operation: incidence, risk factors and outcome

Xu Ming, Shi Zhonghua, Chen Guangqiang, Zhao Jingwei, Shi Guangzhi, Wang Tao, Wang Xin, Tang Mingzhong, Zhou Jianxin

2015, 36(3):  454-458.  doi:10.3969/j.issn.1006-7795.2015.03.023

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Objective To investigate the incidence, risk factors and outcomes of post-craniotomy intracranial infection (PCII) in pediatric patients with supratentorial neurosurgical operation in our hospital.Methods Pediatric patients who were undergone supratentorial neurosurgical operation in our hospital from 2011 to 2012 were included. The medical records, imaging findings, and laboratory were reviewed for investigating the incidence, risk factors, and outcomes of patients had PCII. Results The incidence of PCII was 8.0%. Postoperative drainage tube placement, and postoperative head CT showing intracranial hemorrhage were independent risk factors for PCII (odds ratio <1, P >0.05). Administration of prophylactic antibiotics did not reduce the incidence of PCII.Conclusion The overall incidence of PCII was 8.0%. Patients with PCII had longer hospital stay and higher hospital cost, indicating that patients with PCII should be carefully managed.

Prospective study of BK virus infection in renal transplant recipients in a single-center

Yang Xiaoyong, Ren Liang, Wang Wei, Liu Hang, Hu Xiaopeng, Zhang Xiaodong

2015, 36(3):  459-464.  doi:10.3969/j.issn.1006-7795.2015.03.024

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Objective To explore the incidence and clinical course of BK virus by monitoring of BKV loads in renal transplantation. Methods There are 80 cases of renal transplant recipients were undertaken BK virus detection including urine and serum BKV DNA. To demonstrate the BK virus replication. BKVAN was diagnosed by light microscopic examination and a positive immunohistochemistry staining of anti-SV40 large T antibody in a biopsy specimen. Patients diagnosed with BKVAN were followed up and medical case histories were reviewed. Results Among the 80 patients, BKV viruria, BKV viremia and BKVAN occurred in 37.5%, 8.75% and 2.5% of kidney transplant recipients, respectively. The BKV DNA level in urine and serum remained constant and the peak time of BKV infection was at the sixth month to twelfth month post renal transplantation. Conclusion BKVAN in renal transplant recipients is an important cause of renal transplant dysfunction. Routine BK virus surveillance is effective; It tends to detect BK virus replication early, allowing reduction of immunosuppression, which results in good outcomes with renal preservation.

Expectant treatment of early onset preeclampsia influencing factors on perinatal outcome of children

Miao Xiao

2015, 36(3):  465-468.  doi:10.3969/j.issn.1006-7795.2015.03.025

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Objective To study early-onset pre-eclampsia expectant management of appropriate timing and timing of pregnancy termination. Methods From April 2012 to April 2014 in our treatment of 65 patients with early-onset preeclampsia, according to gestational 28-31⁺⁶ weeks of onset for A group of 38 patients (58.5%,28/65), 32-34 weeks gestational age of onset Group B in 27 cases (41.5%,27/65) were conducted a retrospective analysis of the incidence and outcome of patients. Results The patient age, symptoms, average prolong pregnancy between A and B group have significant differences (P=0.000, P=0.028,P=0.000). HELLP Syndrome and FGR between A and B group has significant difference (P=0.045, P=0.000). The patient gestational age, birth weight of the two group have significant differences (P=0.000, P=0.043). Conclusion Early-onset preeclampsia and perinatal outcomes gestational weeks and birth weight, gestational age of onset for pregnant women is closely related to the disease earlier, more serious illness, higher perinatal morbidity. Treatment must intervene as soon as possible, and close observation of the mother and child safety, personalized selection of gestational weeks, to get the best maternal and neonatal outcomes.

A study on minimum alveolar concentration EI₅₀ and EI₉₅ sevoflurane during intubation with Tosight video larygoscope in neonates

Chen Lili, Zhang Jianmin, Zheng Tiehua

2015, 36(3):  469-472.  doi:10.3969/j.issn.1006-7795.2015.03.026

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Objective To measure the minimum alveolar concentration (MAC EI₅₀ and EI₉₅) of sevoflurane during intubation with Tosight video larygoscope in neonates. Methods Twenty-two ASAⅠor Ⅱ infants under operations in general anesthesia were induced by sevoflurane. Initial concentration is set to 3.3%, the adjacent concentration ratio is 1.1.The concentration of sevoflurane was determined via the modified Dixon's up-and-down method (a level as a step size). After equilibrium between blood and brain concentration of sevoflurane, the trachea was intubated. Probit analysis was used for calculating MAC EI₅₀, EI₉₅ and 95% confidence interval (95%CI). Results The MAC EI₅₀ of sevoflurace was 3.65% (95%CI : 3.28%-4.04%) and EI₉₅ of sevoflurace was 4.24% (95%CI : 3.93%-7.14%). Conclusion The MAC EI₅₀ and EI₉₅ of sevoflurane during Tosight video laryngoscope intubation in neonates were 3.65% and 4.24%.

The cortical bone thickness analysis of different arch form in adult palatal micro-screw anchorage point with cone-beam computed tomography

Duan Shaoyu, Zhang Dongliang, Yang Lian, Bao Shuangling

2015, 36(3):  473-477.  doi:10.3969/j.issn.1006-7795.2015.03.027

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Objective To investigate palatal bone factors associated with different arch form in adult patients. Methods A cone beam computed tomography was obtained from 120 patients, age for 18 to 40 year old. Based on arch forms, the patient's tomography were equally divided into three basic categories: square, tapered, and ovoid, each consisting 40 patients which consist of equal gender. Cortical bone thicknesses of different implant sites in palatal bone were measured. Results There is no statistically difference between different gender. There is no statistically difference of the cortical bone thickness between the midpalatal and 3 mm from the midpalatal. Both of the midpalatal and parapalatal cortical bone thickness is decrease progressively form the foramen. The sequence of the alveolar cortical bone thickness is 56, 45, 67.There are statistically difference between different arch form. Conclusion It is important for orthodontist to consider the cortical bone thickness in different type of arch form and palatal implant sites which will influence the stability of the microscrews.

Combination treatment of refractory periapical periodontitis with nonsurgical endodontic retreatment and apical surgery

Xu Zhiliang

2015, 36(3):  478-482.  doi:10.3969/j.issn.1006-7795.2015.03.028

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Objective To explore the effect of combination treatment of refractory periapical periodontitis with nonsurgical endodontic retreatment and apical surgery. Methods Sixty-eight patients with refractory periapical periodontitis in our hospital from 2008 to 2013 years were selected in this study. These patients were randomly divided into combination treatment group and regular treatment group. Then the treatment effect was observed, and the SPSS 18.0 software was used to analyse the data. Results Thirty-two teeth in patients in combination treatment group exhibited perfect treatment effect (effective rate 91.4%), whereas only twenty-four teeth in patients in regular treatment group got better results after treatment (effective rate 72.72%). There was statistical difference in the effective rates between these two groups. Conclusion Combination treatment with nonsurgical endodontic retreatment and apical surgery could effectively treat the refractory periapical periodontitis. It exhibited nice feasibility and practicality in the stomatology department in general hospital.

Safety and efficacy of embolization coils for post-pancreaticoduodenectomy hemorrhage interventional therapy

Li Jie

2015, 36(3):  483-487.  doi:10.3969/j.issn.1006-7795.2015.03.029

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Objective To discuss safety and efficacy of embolization coils for post-pancreaticoduodenectomy hemorrhage interventional therapy. Methods The clinical data about interventional treatment technology and prognosis of 22 patients who were in emergency cases underwent post-pancreaticoduodenectomy bleeding between June 2008 and August 2012 were retrospectively analyzed in Peking University Cancer Hospital. Results In all 22 patients, 5 cases underwent gastrointestinal bleeding, 15 cases of abdominal bleeding, 2 cases had abdominal cavity and gastrointestinal bleeding. Hemorrhage occurred 8 h-72d after surgery. A total of 27 times interventional procedures were involved. The effective rate of interventional techniques was 92.59%, hemostatic rate of the first interventional procedures was 81.82%. Hemostatic rate of the second interventional procedures was 90.91%. There are 2 patients died, 1 patient was repeated hemorrhage because of celiac infection and failed at last, and 1 patient was failed after embolization. Conclusion After to balance the risk-benefit ratio, the embolization therapy is a technique for patients who have post-pancreaticoduodenectomy bleeding in emergency cases.

Clinic research on PPH combined with external hemorrhoids resection in the treatment of circular mixed hemorrhoids

Liu Fucheng, Xie Kai

2015, 36(3):  488-490.  doi:10.3969/j.issn.1006-7795.2015.03.030

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Objective To explore the treatment effectiveness of procedure for prolapsed and hemorrhoids(PPH) combined with external hemorrhoids resection for the treatment of circular mixed hemorrhoids. Methods Treatment group including 48 cases were treated with PPH combined with external hemorrhoids resection; control group including 48 cases with mixed hemorrhoids Milligan-morgan hemorroidectomy. Results The operation time,postoperative, complication grades were significantly shorter in the treatment group than those in the control group (P <0.05).There was no statistical difference of operative effect between two groups(P >0.05).The hospitalization costs of the treatment group was significantly more than the control group(P <0.05).Conclusion PPH combined with external hemorrhoids resection was effective in treatment.

Ventilation or not? New strategies on cardiopulmonary resuscitation

Wang Shuo, Li Chunsheng

2015, 36(3):  491-496.  doi:10.3969/j.issn.1006-7795.2015.03.031

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New strategy of CPR has been raised and the "C-A-B" (chest compression, airway, and breathing) sequence has been advocated for adults and pediatric patients. Many studies demonstrate that the rescue breathing not so important as previously thought. In this review, we summarize many studies, including Chinese scholars', to elaborate this problem.

Exploring therapeutic mechanisms of traditional Chinese medicine Tongfu granule in preventing sepsis-induced intestinal dysmotility

Su Yanli, Wang Hong, Zhang Shuwen, Wang Baoen, Ren Aimin, Miao Bin, Wang Chao

2015, 36(3):  497-500.  doi:10.3969/j.issn.1006-7795.2015.03.032

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Intestinal dysmotility is the frequent complications in patients with sepsis. Our epidemiological investigation from 37 hospitals in China showed that the incidence of gastrointestinal dysfunction in the severe sepsis patients were 78.8 %. During treatment of gastrointestinal dysfunction in patients with multiple organ dysfunction syndrome (MODS), Tongfu granule (Chinese patents 200710122532.2) treatment was found to enhance the intestinal motility, lower the activity of plasma diamine oxidase (DAO) and level of D-lactic acid, and lower the mortality in 28 days in patients whose APACHE II score was between 8-20. Animal experimental studies showed that in LPS-induced endotoxemia, Tongfu granules were found to protect the intestinal immune function due to reducing the injury of small intestinal mucosa and immune cells and decreasing intestinal lymphocyte apoptosis. In addition, Tongfu granules could protect the intestinal microflora barrier function. Magnolol (5,5-diallyl-2,2-dihydroxybiphenyl) is one of the major active compounds of Tongfu granules. Magnolol treatment was found to prevent by regulating SCF/c-kit and NO signaling to maintain functional interstitial cells of Cajal (ICCs).

Influencing factors and nursing intervention on the compliance to antiviral therapy of patients with hepatitis C

Liu Chen

2015, 36(3):  501-504.  doi:10.3969/j.issn.1006-7795.2015.03.033

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This article aimed to summarize the influencing factors and nursing intervention on the compliance to antiviral therapy of patients with hepatitis C, to let the medical staff pay more attention to the antiviral treatment adherence for patients with hepatitis C, provide the basis for nursing intervention and health education.

The role of endogenous hydrogen sulfide (H₂S) in the rats with diabetic nephropathy (DN)

Huang Wen, Chen Shen, Li Xiaolu, Zhang Hong, Yang Min, Zhang Mei

2015, 36(3):  505-507.  doi:10.3969/j.issn.1006-7795.2015.03.034

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The novel endogenous gasotransmitters-hydrogen sulfide(endogenous H₂S)has the similar features with nitric oxide (NO), such as vascular relaxation, inhibition of vascular smooth muscle cell proliferation and regulation of vascular smooth muscle cells tension. This series study discussed the role of endogenous H₂S in the pathogenesis of diabetic nephropathy, by observing the changes of endogenous H₂S in the kidney of diabetic nephropathy (DN) rats, the relationship between endogenous H₂S and cystathionine 2β2 synthase(CBS) and cystathionine 2γ2 lyase(CSE), the renal pathological changes in DN rats, the effective of endogenous H₂S on the distribution and expression of the myofibroblast characteristic markers-α-smooth muscle actin (α-SMA) and extracellular matrix components-fibronectin (FN) in the kidney of DN rats. Our results showed that 1the production of endogenous H₂S in the kidney of DN rats reduced significantly and CSE in the kidney of DN rats was significantly lower than that in normal rats.2 The reduction of endogenous H₂S was closely related to the pathological changes and clinical symptoms of DN rats.3 The expression and distribution of α-SMA in the kidney tissue of DN rats and FN in mesangial matrix increased,and after supplementation with exogenous H₂S,both of them decreased significantly. The production of endogenous H₂S in the kidney of DN rats decreased significantly, and the reduced level of CSE may be a direct factor. Exogenous supplementation of H₂S can inhibit the generation of myofibroblast and the excessive accumulation of extracellular matrix. Our results suggested the reduced production of endogenous H₂S may correlated with the occurrence of diabetic nephropathy.

A review of different methods for cleaning removable denture

Li Hui, Qi Ji, Wang Yanrong

2015, 36(3):  508-512.  doi:10.3969/j.issn.1006-7795.2015.03.035

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Following the population aging in China, the number of patients missing teeth increases gradually and the proportion of person wearing removable denture goes up. Many studies have been carried out in recent years at home and abroad for such purposes as evaluation of different cleaning methods, the development direction of removable denture and health survey. This article attempted to review about denture cleaning and promoting effective cleaning method,and providing scientific basis for formulating guidelines for denture care and improving the denture wearer's oral health and general health as well.