Volume 91  ·   Issue 14  ·  2011

chronic total occlusions (CTO) are common complex coronary lesions, accounting for about 15% ~30% of all percutaneous coronary intervention (PCI) cases. Successful opening of CTO lesions can improve myocardial ischemia in the distal supply area of occlusion, resuscitate the hibernating myocardium, thereby alleviating the symptoms of angina pectoris and improving the cardiac function of patients, reducing the need of coronary artery bypass grafting (CABG) by more than 50%, and is beneficial to the long-term survival of patients [1]. However, in the past 20 years, despite the widespread application of a large number of new devices and new technologies, nearly 1/3 of CTO failed the initial PCI.

Objective To investigate the endoscopic surgical efficacy of larger benign thyroid tumors and to evaluate its feasibility and safety. Methods Forty-two patients with benign thyroid tumors underwent endoscopic surgery by infraclavicular approach ( a 4 - 6 cm incision on larger side of the tumor ≥3 cm off midline) at our hospital between April 2005 and January 2010. Fifty-four patients were enrolled as controls by conventional approach. Two groups were compared with regards to tumor size, surgical approach,complications, operative duration, hospital stay and incision cosmetic outcomes. Resnlts Two groups were matched by age, sex and tumor size. No statistical significance was found in surgical approach. Pathology examinations proved benign in both groups. The cosmetic results in endoscopic group were obviously favorable than those in conventional group ( 1.6 ±0. 9 vs 5.8 ± 1. 2 ,Z = 8. 418, P =0. 000). All patients were followed up for a period of 6 months to 4 years. Endoscopic group: no permanent glottic paralysis; one patient appeared hypocalcemic and recovered in 1 week; two patients presented with skin tension and alleviated in 3 months; two patients occurred temporary glottic paralysis and recovered in 1 month.Conventional group: no permanent glottic paralysis; three patients appeared temporarily hypocalcemic; no dyspnea from airway collapse; no recurrence. There was no significant distinction between two groups ( x2 =1. 247, P = 0. 459 ). Conclusion Endoscopic surgery by infraclavicular approach is suitable for patients with≥4 cm thyroid tumors.

Objective To explore various tunica albuginea plasty for penile curvature and their efficacies. Methods From July 2005 to July 2008, there were a total of 8 patients with a mean age of 34 ±9 years old (range: 23 -47 ) undergoing corrective surgery for various types of penile curvature. Among them, 4 patients (3 with ventral curvature, 1 with lateral curvature) were treated by 16-dot plication technique, 2 patients of lateral curvature with tightening ring in tunica albuginea corrected by V-Y plasty and 2 patients (one caused by Peyronie's disease while the other by tunica scar contracture) repaired by venous graft patch. The pre-and post-operative levels of sexual satisfaction were evaluated by the International Index of Erectile Function ( IIEF-5 ) scoring system. Results All cases were followed up at 3, 6 & 9 months postoperatively. Their mean curvature at maximal erection was ( 58.2 ± 9. 7 ) °. And a postoperative office assessment revealed a functional straight in all patients [mean degree ( 11 ± 4 )°]. One patient ( 12. 5% )reported penile shortening without dissatisfaetion about it. No patients complained of anesthesia or other sensory abnormality on their penile skin. An improvement of IIEF-5 scores was noted (21 ± 3 vs 15 ± 5,P ＜0. 05) and all patients were satisfied with their outcomes. No complications, such as hematoma,infection or erectile dysfunction, occurred. Conclusion To achieve a better penile morphology and functional outcomes with fewer complications, various orthoplasty should be adopted according to the cause,degree and direction of penile curvature.

Objective To investigate the clinical efficacy of cardiac resynchronization therapy (CRT) through biventricular pacing in chronically right ventricular apical paced patients with heart failure. Methods Ten chronically right ventricular apical paced patients with left ventricular ejection fraction (EF)≤35% underwent CRT upgrading. And the follow-up period was over 12 months. Seven of them reported a significant improvement in their symptoms. Two patients died and one patient had no response. As compared with pre-CRT, CRT significantly improved NYHA classification, decreased left atrium diameter [(43 ±5) mm vs (46 ±7) mm], pulmonary arterial pressure [(42 ±6) mm Hg vs (54 ±13 ) nnn Hg] and BNP [( 184 ± 73 ) ng/L vs ( 545 ± 286 ) ng/L] ( P ＜ 0. 05 ), improved left ventricular EF [(35 ± 5 ) % vs ( 32 ± 4 ) %]. Tissue Doppler imaging revealed the maximal difference of time to peak myocardial systolic contraction of 12 left ventricular segment shortened [(136 ± 28) ms vs (97 ± 18 )ms],interventricular mechanical delay shortened [(52 ± 5 ) ms vs (31 ± 6 ) ms)] after upgrading. Conclusion CRT upgrading from right ventricular apical pacing may improve left ventricular function in patients with heart failure.

Objective To investigate the correlation of endogenous androgen and androgen receptor (AR) level with coronary artery diseases (CAD) in elderly males and elucidate the potential mechanism of gender difference in the prevalence of CAD. Methods A total of 296 male patients from different centers were divided into the CAD group ( n = 237 ) and the control group ( n = 59 ) according to the results of coronary angiography. Their mean ages were 68.6 ± 6. 8 and 66. 2 ± 6. 5 years old respectively. The serum levels of FT (free testosterone), TT (total testosterone), E2 (estradiol), LH (luteinizing hormone), FSH ( follicle-stimulating hormone ), SHBG ( sex hormone-binding globulin ) and DHEA (dehydroepiandrosterone) were measured in all participants. And the androgen receptors of peripheral lymphocytes were assessed by flow cytometry. Results The serum level of FT was lower in the CAD group than that in the control group[(24. 1 ±22. 2) × 10-9 mmol/L vs( 34. 1 ±31.8) × 10-9 mmol/l, P =0. 06]. But two groups showed no statistic differences in the levels of TT, E2 , LH, FSH, SHBG, DHEA and lymphocyte AR (56. 3% ± 24. 00 vs 57.1% ± 20. 8% ). As demonstrated by the logistic regression analysis, the level of FT was negatively correlated with the CAD risk ( OR = 0. 98, P = 0. 0049 ) and positively correlated with the peripheral lymphocyte AR level. However age was negatively correlated with the levels of FT and AR. Conclusion The deficiency of endogenous androgen contributes to a high prevalence of CAD in elderly males. The age-related decreases of FT and AR impair the physiological functions of androgen so as to accelerate the progression of coronary atherosclerosis.

Objective To determine the normal values for thromboelastography (TEG) in Chinese healthy adult volunteers residing in Beijing for over three years and compare them with those of the manufacturer's. Methods A total of 137 healthy adult volunteers were enrolled from June 2010 to August 2010. The technique was standardized with citrated blood and kaolin activator. And a Haemoscope 5000 device was employed. The TEG parameters analyzed were R, K, α, maximal amplitude ( MA), LY30 and coagulation index ( CI). All volunteers underwent the tests of prothrombin time ( PT), activated partial thromboplastin time (APTT), thrombin time (TT) and plasma fibrinogen level with the same blood sample. Results The reference ranges of 95% for 137 volunteers were R:3.8 - 8.4 min, K:0. 8 - 3.3min, α-Angle:46.2 -76.2°, MA: 50.0-70.8 mm, LY30: -3.3% -4.0% and CI: -3.8 -2.9.Overall, 24. 1% (33/137) of the volunteers had at least one abnormal parameter while 7.3% (10/137)would have been considered coagulopathy had the manufacturer's reference values been used, resulting in a test specificity of 76.0%. As compared with the western ethnicity ( the manufacturer's reference values),Chinese healthy volunteers were associated with lower fibrinogen functions. There were significantly diffenrent in R, K, α-Angle, MA and CI bettween men and women groups( all P ＜0. 01 ). Conclusion This study supports the manufacturer's recommendation that each institute should determine its own normal reference values.

Objective To investigate the incidence of remifentanil-induced hyperalgesia and screen for the relevant influencing factors in the post-operative patients. Methods A total of 1620 patients from June 2008 to December 2008 in our hospital undergoing general anesthesia with remifentanil and whose length of operative incision was less than 4 cm were enrolled . The incidence of postoperative hyperalgesia was investigated and recorded at the timepoints of staying at post-anesthesia care unit ( PACU ), 4 h and 24 h postoperation respectively. The unconditional statistical analysis of Logistic regression was used to explore such possible influencing factors as age, gender, methods of general anesthesia, operative duration,operative sites and remifentanil dose. Results The incidence of postoperative remifentanil-induced hyperalgesia was 16.1% (n = 261 ). The incidence of postoperative hyperalgesia was significantly increased in patients ＜ 16 yrs (25.9%) vs ≥ 16 yrs ( 15.6% ) (P ＜ 0.05), males vs females (20.8% vs 13.0%,P＜0.01), operative duration ＞2 h (32.7%) vs ≤ 2 h (9.9%) (P＜0.01) and remifentanil dose ＞30 μg/kg (41.8%) vs ≤30 μg/kg (4.8%) (P ＜0.01 ). And the incidence of limb protective action,touch and cold-induced allodynia were the two highest indicators (39.0%, 34.5% ). Analysis of Logistic regression showed that ages under 16 years old, operative duration ＞2 h and remifentanil dose ＞30 μg/kg were relevant with hyperalgesia (all P ＜ 0.05 ). Conclusion Ages under 16 years old, operative duration and remifentanil dose are the risk factors for postoperative remifentanil-induced hyperalgesia. Neither methods of general anesthesia nor operative sites has any effect on the occurrence of hyperalgesia.

Objective To investigate the correlation of somatic mutations in whole genome of mitochondrial DNA ( mtDNA ) in patients with breast tumor. Methods The DNA of tumor tissue and peripheral blood in 4 benign breast tumor patients from August 2009 to December 2009 in our hospital were extracted. The mtDNA whole genomes were amplified by polymerase chain reaction (PCR) and the mutations of products screened by sequencing to compare the difference of mutation distribution between tumor tissue and peripheral blood. The likelihood of somatic mutations in tumor tissue was determined. Results The mutation spectrum of mtDNA genomes was obtained by PGR and sequencing. Then a phylogenetic tree was constructed to identify their haplogroups (D4i, G1, R9b, N9a). Their private mutations in peripheral blood were detected and the somatic mutation at 16292 position was found in one patient ( haplogroups: R9b).Conclusion Based on the extensively study on the mtDNA genomes from the tumor issues of 4 patients, our current report observed only a single somatic variation from the control region, no any further mutations with potential function from the coding region were observed.

Objective To investigate the spectrum of mitochondrial DNA (deoxyribonucleic acid)3271T＞C, 8356T ＞ C, 9176T ＞ C/G and 13513G ＞ A mutations in Chinese patients with mitochondrial encephalomyopathies. Methods Peripheral blood samples were collected from 500 mitochondrial encephalomyopathic patients clinically diagnosed as mitochondrial encephalomyopathy lactic acidosis & stroke-like episodes (MELAS), myoclonus epilepsy & ragged-red fibers (MERRF) or Leigh's syndrome from October 2005 to October 2009. The methods of PCR- polymerase chain reaction-restriction fragment length polymorphism ( RFLP ) and PCR-sequencing were performed to identify the mutations. Results No patients with the 3271T ＞ C, 8356T ＞ C, 9176T ＞ C/G or 13513G ＞ A mutations were identified.Conclusion The mutations of 3271T ＞ C, 8356T ＞ C, 9176T ＞ C/G and 13513G ＞ A are rare causes of mitochondrial encephalomyopathies in Chinese patients.

Objective To analyze the functional efficacies and complications for the reconstruction of defects in proximal humerus tumors with massive osteoarticular allograft transplantation and evaluate the feasibility of this method. Methods A retrospective review was performed for proximal humerus tumors surgically treated and followed up from November 2001 to November 2008. There were 6 males and 1 female with an average age of 38.4 years old (range :21 -65 ). The tumor characteristics were as follows: giant cell tumor ( n = 5 ), osteosarcoma ( n = 1 ) and malignant fibrous tissue tumor ( n = 1 ). According to the Enneking classification system, there were Ⅰ A (n = 5), Ⅱ A (n = 1 ) and Ⅱ B ( n = 1 ). All patients were reconstructed with massive osteoarticular allograft transplantation and immobilized with interlocking nail. The average length of massive allograft was 15. 2 cm ( range: 11 - 19). Results All patients were followed up for an average of 5. 5 years (range: 2- 8). In a long-term follow-up, atrophy and adsorption of allograft were found in all cases without clinical symptoms. This phenomenon started to appear after 1.5 years. And bone graft disappeared completely in around 6 years postoperatively. The atrophy of bone graft usually originated from greater tubercles and extended gradually to metaphysic. According to the Musculosketetal Tumor Society (MSTS) functional classification system, the average score of osteoarticular allografts was 17.6 (range: 15 -19). According to the MSTS radiological evaluation system, the long-term perfect/fair rate was 0. Conclusion Massive osteoarticular allograft transplantation is one of feasible options for the reconstruction of structural bone defects due to bone tumor resection.

Objective To explore the optimal technique of digestive tract reconstruction for radical proximal gastrectomy. Methods The clinical data for 120 cases of proximal gastric cancer undergoing radical proximal gastrectomy at our hospital from 2000 to 2009 were analyzed retrospectively. They included three approaches of digestive tract reconstruction. The patients were divided into esophagogastric anterior wall anastomosis group ( n = 50 ), jejunal interposition group ( n = 26 ) and gastric tube group ( n = 44 ). The quality of life was evaluated and compared among 3 groups. Results The rates of anastomotic fistula,anastomotic obstruction and the scores of heart burn and reflux esophagitis were higher in gastric tube group.And the increments of hemoglobin and body weight were less in gastric tube group than those in other groups (P ＜ 0. 05 ). The rates of gastric emptying in gastric tube group had no obvious differences with esophagogastric anterior wall anastomosis group at 120 min and 180 min ( P ＞ 0. 05 ). And they were higher than those in jejunal interposition group ( P ＜ 0. 05 ). There was no statistical difference in any parameter between esophagogastric anterior wall anastomosis and jejunal interposition groups ( P ＞ 0. 05 ). Conclusion The anastomosis of esophagogastric anterior wall is an ideal approach of digestive reconstruction for radical proximal gastrectomy. And it may improve the quality of life for surgical patients with proximal gastric cancer.

Objective To investigate the effect of baicalin on pulmonary functions and its mechanism during the development of acute respiratory distress syndrome (ARDS) induced by oleic acid (OA) in rats. Methods Rats were randomized into 5 groups: control, ARDS (OA induction, 0.12 mg/kg),baicalin-treated group ( 150 mg/kg), baicalin-treated group (300 mg/kg) and baicalin-treated group (450mg/kg). The blood samples and lung tissue were collected at 10 min, 1, 2 and 6 h after OA injection. The lung concentration of myeloperoxidase (MPO) was detected by an ELISA (enzyme-linked immunosorbent assay) kit. Meanwhile, blood gas analysis and pulmonary pathological examination were also performed. Results The level of arterial oxygen partial pressure and oxygenation index decreased (P ＜0. 01vs. control) and oxygenation index ( 190 mm Hg, 1 mm Hg =0. 133 kPa) reached the diagnostic standard of ARDS at 2 h in ARDS group. In baicalin-treated group ( 150 mg/kg and 300 mg/kg), the level of arterial oxygen partial pressure and oxygenation index increased versus the ARDS group. In baicalin-treated group (450 mg/kg), the level of arterial oxygen partial pressure was undifferentiated at 1,2 and 6 h (P ＞0. 05)and decreased at 10 min (46. 8 mm Hg, P ＜0. 05 ) versus the ARDS group. The level of MPO increased in baicalin-treated (300 mg/kg) and ARDS groups. Compared with the ARDS group, the level of MPO decreased significantly in baicalin-treated group (300 mg/kg) at 10 min, 1 and 2 h. Meanwhile, the pulmonary pathological damage improved in baicalin-treated group (300 mg/kg). Conclusion An appropriate dose of baicalin may improve hypoxemia of ARDS induced by OA in rats. It may be due to the inhibition of MPO activity.

Objective To investigate the effect of thin split-thickness skin, inter-mediate thickness skin and full-thickness skin autograft on the differentiation of fibroblasts into myofibroblasts in rats after deep partial thickness burn. Methods A total of 40 SD rats were divided randomly into two groups (Group A & Group B, n =20 each). In Group A, tissue samples were collected at Day 2 after skin-grafting while Day 7in Group B. In each group, every rat was scalded to cause deep partial thickness wound with an area of 10% of total body surface. The wounds received eschar shaving instantly coupled with skin-autograft, covering with thin split-thickness skin, inter-mediate thickness skin and full-thickness skin respectively. Meanwhile the control wound on the same rat was scalded only. Then the expression of α-SMA was detected by immunohistochemistry in each wound. And the numbers of myofibroblasts (α-SMA positive cells ) and fibroblasts (negative cells) were counted to calculate the conversion ratio of myofibroblasts. Results In Group A, the conversion ratios of myofibroblasts of control, thin split-thickness skin autograft, inter-mediate thickness skin and full-thickness skin groups were (76. 3 ±3. 3)%, (69. 8 ± 1.6)%, (57.5 ± 1.6)% and (44. 7 ± 1.7 ) % respectively. In Group B, the ratios were (72. 9 ± 6. 1 ) %, ( 63.6 ± 4. 7 ) %, ( 50. 2 ±1.6)% and (32. 3 ± 1.2)% respectively. The ratio was higher in control group than that in any other one (P ＜0. 01 ). There was statistic difference between thin split-thickness skin, inter-mediate thickness skin and full-thickness skin autograft groups ( P ＜ 0. 05 ). Conclusion A direct association may exist between the conversion ratio of myofibroblasts and the application of skin-grafting in rats after deep partial thickness scalding. It is probably related with varying degrees of scar contracture in the long-term.

Ulcerative colitis (UC) is often accompanied by an increase in circulating activated granules, granulocytes and monocytes/macrophage (GM) and related pro-inflammatory factors, as well as an increase in the level of circulating immune complexes in the body. The intestinal damage of active UC is also related to the degree of local GM infiltration. Therefore, removing some leukocytes may be beneficial to alleviate the disease. Japanese scholars first tried and developed leukocytapheresis (LCAP) to treat UC, and then it was put into clinical use in Britain, the United States, Australia and Canada [1].

Spinal injection of BoNT/A (botulinum toxin type A) can sustainably reduce pain response.The researchers applied a standard experimental model of pain in mice to investigate the effect of spinal (intrathecal) injection of BoNT/A.In this model,subcutaneous injection of 40% formaldehyde into the plantar of mice produced the expected biphasic inflammatory pain response.Pain behavior was monitored in mice with or without spinal injection of botulinum neurotoxin for up to 4 weeks.Even a single spinal injection of botulinum neurotoxin produced a pain-relieving response:Pain behavior was significantly reduced in mice receiving the injection,especially in the second stage of the pain response.

The patient was a 12-year-old male, 130 cm tall and 25 kg weighted. He was admitted to our hospital in October 2010 due to intermittent non-febrile convulsions for 1 month. The convulsions all appeared when he was awake during the day. The manifestations were strabismus in both eyes, spitting, and straight twitching in the left limb. He refused to respond to the call, lasting for 5~10 minutes. After relief, he was fatigued, and the reaction stopped after waking up, one of which was accompanied by urinary incontinence. General situation: the mental reaction is still good at ordinary times, easy to be fatigued, and he does not like to move. Neonatal status: full-term natural delivery, no asphyxia after birth, and physical health in the neonatal period. Developmental status: he can raise his head at 2 months and sit alone at 6 months, and his development is normal from childhood.